The use of 1.5 T magnetic resonance imaging for therapeutic decisions in patients with cardiac implantable electronic devices and significant neurological, neurosurgical and neuro-oncology diagnostic indications.

UNLABELLED: Between September 2009 and May 2014 the classification of 36 patients with cardiac implantable electronic devices (CIEDs) in terms of the feasibility of MRI scanning due to strong clinical indications was carried out. Finally MRI examinations were performed in 20 patients, of whom 27 studies were conducted and a total number of 35 anatomical regions were scanned. Neurological, neurosurgical and neuro-oncology indications for MRI were reported in 19 patients (95%) in whom 26 MRI studies (96.3%) were performed, and 34 anatomical regions (97.1%) were scanned. One patient had indications for MRI in the field of cardiology. Medical information obtained from 27 MRI studies allowed decisions to be made regarding the treatment in all patients. After 8 studies (29.6%), patients were classified into 9 different neurosurgical procedures. In the case of the remaining 19 studies (70.4%), there were no indications for surgical treatment and the decisions to implement conservative treatment were made. There were no complications related to the implanted CIEDs observed: neither immediate nor in the follow-up.

Obsessive-compulsive disorder secondary to a right parietal lobe haemorrhage: a case report.

This case report presents a 39-year-old previously healthy man, who presented with typical obsessive-compulsive disorder and neurological symptoms and was found to have a right parietal lobe haemorrhage. His psychiatric and neurological recovery was associated with a complete radiological resolution. This report is consistent with recent imaging studies implicating the parietal lobe in the pathogenesis of obsessive-compulsive disorder and adds haemorrhage to the list of organic cerebral lesions causally associated with this disorder.

A follow-up of 130 patients with acromegaly in a single centre.

OBJECTIVES: Acromegaly is a rare disease with increased mortality rate. The aim was to present our centre experience in the diagnosis and treatment of a series of patients suffering from acromegaly. METHODS: 130 patients (55 men, 75 women) aged 19-84 years presenting with clinical and hormonal features of acromegaly, attending Department of Endocrinology and Out-patient Clinic between 1990 and 2004 were studied. They were analyzed their GH and IGF-1 levels, CT and MRI scans, and they were administered medical therapy, neurosurgery and radiotherapy. RESULTS: We have observed 106 macro-, 16 microadenomas and 1 case of ectopic GHRH. 115 patients were operated, as cured were recognized 74 of them. Pituitary irradiation was applied to 11 patients, in 4 of them it did not cure the disease. Medical therapy was efficacious in 12% patients treated with bromocriptine, 73% with long-acting lanreotide and 58% with long-acting octreotide. In 7 patients other malignant neoplasm were detected. 11 patients died during the follow-up. CONCLUSIONS: There is possible underdiagnosis of acromegaly in our region, especially in males. We have observed better diagnostic opportunities in recent years when MRI was available. It was accompanied by better outcome of surgical and pharmacological treatment and better control of the complications of the disease.

[Reconstruction of the sellar floor in transsphenoidal surgery: our experience of 818 patients]. / Rekonstrukcja dna siodla tureckiego po przezklinowej operacji guzów przysadki: doswiadczenia na podstawie 818 przeprowadzonych operacji.

BACKGROUND AND PURPOSE: Transsphenoidal microsurgery (TSS) is the method of choice for resection of most pituitary tumors. Postoperative cerebrospinal fluid rhinorrhea is one of the most frequent complications of TSS. Its incidence ranges from 1.3 to 9.6%. Failure to close a cerebrospinal fistula can result in life-threatening complications e. g. meningitis or tension pneumocephalus. Therefore sellar closure has to be done properly certainly and has to be watertight. The aim of the study was to evaluate the results of reconstruction of the skull base after TSS with autologous material (fascia lata and fat or muscle). MATERIAL AND METHODS: Our operative experience of reconstruction of the sellar floor during transsphenoidal surgery is described. We report the well known method of the sellar closure using autologous tissue (fascia lata and fat or muscle). We did not use other materials e.g., fibrin glue, titanium mesh etc. This technique has been performed in 316 patients. RESULTS: The postoperative cerebrospinal fluid leakage occurred in 7 patients. Four of them underwent early reoperation. Three others were treated successfully with lumbar drainage. In another patient, a cerebrospinal fistula occurred during chronic pharmacotherapy of the giant PRL-secreting adenoma. Transsphenoidal reconstruction of the skull base according to the described method was performed in that case. Lethal meningitis occurred in one patient in our group. CONCLUSION: In our opinion the described method of reconstruction of the sellar floor is easy, safe and very effective.

[Severe cardiovascular complications due to the pituitary adenoma with acromegaly. An interdisciplinary approach to the treatment. A case report]. / Ciezkie powiklania sercowo-naczyniowe w przebiegu guza przysadki powodujacego akromegalie. Propozycja równoczesnego wielospecjalistycznego leczenia. Opis przypadku.

Acromegaly reduces life expectancy and leads to 3-5-fold increase in mortality. The main causes are cardiovascular, pulmonary and enhanced prevalence of deaths from malignancy. Successful therapy ought to normalize GH, IGF-I secretion, remove the adenoma mass and its local pressure effects and preserve pituitary functions intact to improve systemic morbidity and normalize mortality. The primary therapy for most patients with acromegaly is still transsphenoidal adenomectomy. The authors present a 64-year-old woman with diagnosed GH-secreting pituitary macroadenoma suffering from severe coronary heart disease and diabetes mellitus. Somatostatin analogue therapy was ineffective in our patient. She was unfit for transsphenoidal adenomectomy. The patient was qualified for coronary artery bypass grafting after cardiological investigation. We have decided to carry out the bypass grafting and transsphenoidal adenomectomy during one anaesthesia. Both surgical procedures and postoperative time were uncomplicated. Our patient feels well and she is in outpatient follow-up.

[Intrasellar arachnoid cyst. A case report and review of the literature]. / Sródsiodlowa torbiel pajeczynówki. Opis przypadku i przeglad pismiennictwa.

Intrasellar arachnoid cyst (IAC) is a very rare pathological lesion occurring in 5 of 1000 autopsy cases, and constitutes 9% of all arachnoid cysts. As a space-occupying mass, IAC may cause headaches, visual disturbances, hypopituitarism, precocious puberty, and the "bobble-head doll" syndrome. The pathogenesis of IAC remains controversial. Magnetic resonance imaging (MRI) is the neurodiagnostic tool of choice to evaluate IAC. The authors presented a 38 year-old woman suffering from severe chronic headaches, dysmenorrhea, and visual disturbance. MRI revealed an intrasellar cystic lesion that had compressed the optic chiasma. Preoperative endocrinological assessment revealed hyperprolactinemia and hypogonadotropic hypogonadism. The patient underwent transsphenoidal surgery. The cyst membrane was opened and clear, serous fluid was evacuated. The postoperative course was complicated by CSF leakage, which was corrected by an autologous fat graft placement. Visual field defects improved immediately after surgery but a transient panhypopituitarism and diabetes insipidus occurred. Postoperative MRI revealed no recurrence of the lesion during the four-year follow-up.

La llamada depresión mayor en el curso de la enfermedad de cáncer diseminado con metástasis numerosas / The call major depression in the course of the disseminated cancer with multiple metastases

Muchos autores demuestran, sobre los ejemplos de sus pacientes, que sertralina es una medicación más eficaz y mejor tolerada en el tratamiento de la "depresión mayor" en el curso de las enfermedades de cáncer con metástasis. Presentamos el caso de una entrenadora de gimnasia.

La llamada depresión mayor en el curso de la enfermedad de cáncer diseminado con metástasis numerosas / The call major depression in the course of the disseminated cancer with multiple metastases

Muchos autores demuestran, sobre los ejemplos de sus pacientes, que sertralina es una medicación más eficaz y mejor tolerada en el tratamiento de la "depresión mayor" en el curso de las enfermedades de cáncer con metástasis. Presentamos el caso de una entrenadora de gimnasia. (AU)

[Radionuclide cisternography in the diagnosis of normal pressure hydrocephalus]. / Cysternografia radioizotopowa w rozpoznawaniu wodoglowia z prawidlowym cisnieniem plynu mózgowo-rdzeniowego.

An overview of significant research results of the last four decades as well as the author's own experience have served as a basis for the presentation of the radioisotope method and the radiopharmaceuticals in the diagnostics of normal pressure hydrocephalus (NPH). Also the physiology of the formation of PM-R its flow and absorption have shortly been discussed. Hydrocephalus is a major clinical, diagnostic and therapeutical problem. In the initial diagnosis of that pathology, methods like CT and MRI play an important role, which has also been the subject of this article. A clear and useful classification of hydrocephalus has been presented as well as NPH in adults as a clinical pathological syndrome together with its etiology, diagnostics and the differentiation in relation to other forms of hydrocephalus. Hydrocephalus and the atrophy of the brain have been illustrated by images taken by the author. In the assessment of the NPH in terms of a patient's qualification for a shunting operation a number of diagnostic factors are of particular importance. These are: the infusion test using PM-R pressure measurement of the ventricle system or the subarachnoid space on the spinal cord level, the neuropsychological evaluation as well as the brain imaging using emission tomography SPECT or the measuring of the brain metabolism by PET technique. None of these methods has been universal in diagnostic terms. Radionuclide cisternography seems to be the most physiological method that allows to gain more direct insight into the dynamics and the PM-R flow and its absorption. The results of the radioisotope examination turn out to be the most reliable criterion in the diagnostics of NPH.

[Preliminary evaluation of risk and effectiveness of early choline alphoscerate treatment in craniocerebral injury]. / Wstepna ocena ryzyka oraz skutecznosci wczesnego wlaczenia alfosceranu choliny w leczeniu urazów czaszkowo-mózgowych.

UNLABELLED: Pharmacological treatment of craniocerebral injuries (CCI) to a large extent involves correction of metabolic disturbances resulting from primary and secondary mechanisms of trauma. Choline alphoscerate (CA), a substrate of phosphatydylocholine and a carrier of choline, plays a major role in phospholipidic transformation of the neuronal cell wall. OBJECTIVE: To goal of the study was to evaluate the risk and efficacy of early CA treatment in patients with CCI. MATERIAL: Twenty three CCI patients were treated with CA in the years 2001-2002. In 8 cases an acute subdural haematoma with multiple hemorrhagic foci was diagnosed. Six patients were diagnosed with cerebral contusion with multiple hemorrhagic foci, while 9 patients suffered from concussion of the brain. The patients' condition was assessed at admission using the adult trauma score (ATS)--11 patients scored 8 points on the ATS, 4 patients scored 9, and 8 patients scored 11 points. METHODS: The inclusion criterion was the patient's clinical status at admission in the range 8-11 ATS points. CA was administered according to the following schedule: 1.0 g/d i.m. for 14 days, then 0.8 g/d orally for the next 28 days. AC (Gliatilin) produced by Italfarmaco was used in the study. The cost of this CA treatment was estimated by the producer at PLN 424. RESULTS: After three months of the treatment an improvement was noted in 96% of the patients. Fourteen patients were independent and professionally active, another five were independent, but did not work, while three patients required permanent care. One patient died because of pneumonia. No complications due to the CA treatment were observed in the group studied. CONCLUSIONS: Early treatment with CA is safe and as a component of complex pharmacotherapy has a beneficial effect on the treatment outcome in CCI patients.

[Neuroendoscopy in the treatment of third ventricular hydrocephalus accompanying tumors of the posterior part of the third ventricle in children]. / Neuroendoskopia w leczeniu wodoglowia trójkomorowego w przebiegu guzów tylnej czesci komory trzeciej mózgu u dzieci.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of endoscopic third ventriculostomy (ETV) in non-communicating hydrocephalus secondary to tumour of the posterior part of the third ventricle tumours in children. MATERIAL AND METHODS: The study group consisted of 32 patients (13 girls and 19 boys) treated at the Department of Neurosurgery Children's Memorial Health Institute in Warsaw in the years 1996-2000. In 22 cases benign tectal mass (BTM) and 10 malignant neoplasms (including 9 germ cell tumours and 1 ependymoma) were diagnosed. The follow-up period after ETV ranged from 5 months to 4 years (mean 21 months). The retrospective analysis of medical reports and control CTs, MRs, and PC MR-cine studies was performed. RESULTS: In all the patients the early (up to 3 months postop) outcomes were good. 8 patients with malignant neoplasms after initial chemotherapy underwent residual tumor excision (more than 3 months after ETVs) and in two of them the CFS meningeal tumor spreads were detected. In 26 (81%) of the patients permanent control of hydrocephalus was achieved. The recurrence of active hydrocephalus was observed in 6 cases (19%). 3 of them were children with benign tectal masses and 3 with malignant tumours. The reason of failure in 2 cases was associated with meningeal tumor dissemination, and in one with postoperative bleeding after surgical tumor excision (communicating hydrocephalus). In 2 cases with benign tumours reasons of failures were not clear (patent stomies on PC MR-cine) and in 1 case late stomy occlusion on PC-MR flow study was diagnosed. Five out of 6 patients underwent shunt placements and in 1 case with late ventriculostomy occlusion another endoscopic procedure (after 26 months) was successfully performed. CONCLUSIONS: The endoscopic third ventriculostomy was an efficient method to control non-communicating hydrocephalus in children with posterior part of the third ventricle brain tumours. The PC MR flow study was a useful diagnostic tool in the stomy patency evaluation and in further treatment planning in cases of failures. It seems that recurrence of active hydrocephalus can be successfully treated with repeated ETV when the stomy occlusion is detected on MR flow studies. Other cases of failures ought to be treated by shunt implantations.

[Surgical treatment of trigeminal neurinoma]. / Leczenie operacyjne nerwiaków nerwu trójdzielnego.

The article presents the group of five patients with clinical and radiological symptoms of trigeminal neurinoma that were operated on in the Neurosurgical Clinic of Central Clinical Hospital of Military Medical Academy in the five-years period (1995-2000). Three of them were operated in a single step procedure from subtemporal and suboccipital approach. Two other were operated in two steps, also from subtemporal and suboccipital approaches. Four neurinomas were removed radically, as confirmed by CT, and MRI scans. All the patients are independent and professionally active. Complications observed after the operation were: persistent anaesthesia in the trigeminal area, atrophy of the masseter muscle, transient paresis of the facial nerve with ulceration and opacification of the cornea, and transient paresis of the abducens nerve.

[Posttraumatic visual agnosia and epilepsy as a consequence of gunshot injury to the head. Case report]. / Pourazowa agnozja wzrokowa i padaczka jako powiklanie rany postrzalowej glowy. Opis przypadku.

Half million people in the world, each year have a gunshot injury to the head and eighty thousand of them are hospitalized. Gunshot injuries to the head have became in Poland second most frequent cause of death from head trauma, and in some countries during peace became the most frequent cause of death among patient with head injury. Glasgow Coma Scale (GCS) is a useful prognostic factor for patients with gunshot injury to the head. Injury to the eloquent regions of the brain, commotion and contusion of the brain, intracranial hematomas, subarachnoid hemorrhage, cerebro-vascular spasm, injuries to the major vessels, liquorrhea, infections, coagulopathies and epilepsy are the most important and influential factors in the clinical status of the patient with gunshot injury to the head. The operation is the preferred treatment to all patient, no matter of their clinical status at the moment of the admission. The report presents the history of treatment of a patient with gunshot injury to the head. During the treatment extremely infrequently occurring posttraumatic visual agnosia and posttraumatic epilepsy were observed. Twenty-two months after operation the patient is independent and professionally active.