[Direct surgical outcome of meningiomas obliterating the superior sagittal sinus]. / Bezposrednie wyniki leczenia operacyjnego oponiaków obliterujacych zatoke strzalkowa górna.

BACKGROUND AND PURPOSE: Aggressive surgery for parasagittal meningiomas is considered when superior sagittal sinus is totally thrombosed by the tumour. However, there is potential risk of venous outflow injury resulting in an intracerebral haemorrhage. The aim of this study is to present surgical technique and early surgical outcome of patients with meningiomas obliterating the superior sagittal sinus. MATERIAL AND METHODS: Ten patients (4 men and 6 women, mean age 58), operated for sagittal meningiomas with radiologically proved superior sagittal sinus obliteration, were analysed retrospectively. In all cases, radical surgery with the resection of invaded sagittal sinus was performed. The size of tumours varied between 35 and 100 mm; the mean was 53 mm. Five of them required reoperation because of tumour recurrence due to a previous incomplete resection. In five cases, bifrontal craniotomy was made, in four biparietal and in one parieto-occipital. Preoperative status and direct postoperative outcome were compared using the Karnofsky scale. RESULTS: Very good outcome was achieved in 6 cases--the clinical status remained unchanged. In two, the outcome was good (in the first patient hemiparesis increased and in the second there was worsening of cortical visual disturbances). In two cases with an unfavorable outcome, one patient suffered quadriparesis and mutism; the other experienced cerebral edema with hemorrhagic infarct and died despite decompressive surgery. Both these patients were totally dependent before surgery (Karnofsky < 40). CONCLUSIONS: In the radical resection of a tumour with occluded sinus, direct postoperative outcome ranges from good to very good in a significant number of cases. In dependent patients having a large tumour, there is the risk of an unfavourable outcome after radical surgery. In such cases, partial resection and further radiotherapy should be considered.

[Mechanically detachable coils in the treatment of posterior circulation aneurysms: a comparison with surgical repair]. / Mechanicznie odszczepialne spirale w leczeniu tetniaków ukladu kregowo-podstawnego-- porównanie z metoda chirurgiczna.

AIM: To compare craniotomy and clip application with endovascular coiling in patients with posterior circulation aneurysms. MATERIAL AND METHODS: Among 676 consecutive patients with aneurysmal SAH who had been treated with either clipping or coiling, a group of 46 patients with aneurysms in the posterior circulation (32 treated surgically and 14 endovascularly) were selected for further investigation. Patient and aneurysm characteristics, procedural complications, and clinical and radiological results were compared retrospectively. The odds ratio for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for preoperative clinical condition parameters was assessed by logistic regression analysis. The group was not randomized. RESULTS: In the endovascular group 6 patients (42.9%) had a poor outcome vs. 8 (25%) in the surgical group; the adjusted odds ratio for poor outcome after coiling vs. clipping was 3.21 (p = NS). The observed difference in outcome was consequent on higher incidence of severe neurological deficit (GOS 3) after embolisation, compared with clip application (26% and 9.4% of patients respectively); mortality was comparable in both groups (14.3% vs. 15.6%). Optimal or suboptimal aneurysm occlusion immediately after coiling was achieved in 12 patients (85.7%). Clipping was successful in 31 patients (96.9%). CONCLUSION: There was no statistically significant difference in outcome between the two treatment groups. However, patients were less likely to be dependent when treated by craniotomy and clip application, compared with endovascular MDS embolisation.

[Endovascular coiling and microsurgery of the cerebral arteriovenous malformations. Assessment of criteria of treatment and outcome]. / Embolizacja wewnatrznaczyniowa i mikrochirurgia naczyniaków tetniczo-zylnych mózgu. Ocena kryteriów stosowanych w wyborze postepowania oraz wyniki leczenia.

BACKGROUND: Three available methods of therapy of arteriovenous malformations (AVM) i.e. microsurgical resection, intravascular embolization and stereotactic radiosurgery, make possible definitive treatment in the majority of patients. During qualification to these procedures the risk of complications and efficacy of each method should be considered. OBJECTIVE: To analyze criteria of qualification, risk factors and results of embolization and surgical treatment of AVMs. PATIENTS AND METHODS: Within four years (1999-2002) 53 patients were treated for arteriovenous malformations (AVMs) in the Department of Neurosurgery of the University Hospital in Krakow (24 women and 29 men). The group of 25 patients was treated with intravascular embolization, 20 patients were operated and 8 patients were treated conservatively or were qualified to radiotherapy. We retrospectively analyzed clinical findings, criteria of qualification and results of embolization as well as microsurgical treatment of AVMs with regard to Spetzler-Martin scale. RESULTS: 25 patients qualified for embolization underwent 39 embolization procedures. Complete embolization of AVM was obtained in 4 (16%) cases. 18 patients (72%) presented very good or good condition on discharge. In 5 (20%) serious complications were noted: in 2 hemorrhagic and in 3 ischemic. Three patients (12%) died. In the group of 18 operated patients, 13 (72%) patients presented very good or good condition on discharge and 1 patient died because of hemorrhagic complications. CONCLUSIONS: 1. Spetzler-Martin scale is very useful in evaluation of operative risk of AVM operations but, in our opinion, before operation there should be considered also such factors like number and diameter of feeding arteries, exact localization of AVM and initial condition of the patient. 2. Although intravascular embolization is less invasive than neurosurgical operation, the risk of hemorrhagic and ischemic complications is present. 3. Complete AVM embolization is possible in the minority of patients. The remaining group require follow up and control radiological examinations to establish indications for further treatment.