Functional rearrangement of the primary and secondary motor cortex in patients with primary tumors of the central nervous system located in the region of the central sulcus depending on the histopathological type and the size of tumor: Examination by means of functional magnetic resonance imaging.

BACKGROUND: The aim of this study was to analyze the reorganization of the centers of the motor cortex in patients with primary neuroepithelial tumors of the central nervous system (CNS) located in the region of the central sulcus in relation to the histopathological type and the size of tumor, as determined by means of functional magnetic resonance imaging (fMRI). MATERIAL/METHODS: The fMRI was performed prior to the surgical treatment of patients with tumors located in the region of the central sulcus (WHO stage I and II, n=15; WHO stage III and IV, n=25). The analysis included a record of the activity in the areas of the primary motor cortex (M1) and the secondary motor cortex: the premotor cortex (PMA) and the accessory motor area (SMA). The results were correlated with the histopathological type of the tumor and its size expressed in cm(3). RESULTS: The frequency of activation of the motor center was higher in the group of patients who had less aggressive tumors, such as low-grade glioma (LGG), as well as in tumors of lower volume, and this was true both for the hemisphere where the tumor was located and in the contralateral one. Mean values of t-statistics of activation intensity, mean numbers of activated clusters, and their ranges were lower in all analyzed motor areas of LGG tumors. The values of t-statistics and activation areas were higher in the case of small tumors located in ipsilateral centers, and in large tumors located in contralateral centers, aside from the SMA area where the values of t-statistics were equal for both groups. The contralateral SMA area was characterized by the highest stability of all examined centers of secondary motor cortex. No significant association (p>0.05) was observed between the absolute value of the mean registered activity (t-statistics) and the size of examined areas (number of clusters) when the groups were stratified with regards to the analyzed parameters. CONCLUSIONS: The presence of a neoplastic lesion, its histopathological type and finally its size modulate the functional reorganization of the motor centers as suggested by the differences in the frequency of the neural center activation in the analyzed groups. Processes of functional rearrangement are more pronounced and more precisely defined in patients with less aggressive and/or smaller tumors. The contralateral accessory area is the most frequently activated center in all analyzed groups irrespective of the grade and size of the tumor.

Polypropylene-polyester cranial prostheses prepared with CAD/CAM technology. Report of first 15 cases.

OBJECTIVES: The authors described a new cranioplastic method where polypropylene-polyester knitwear was shaped according to individual patient's skull 3D model. The material was formed in a customized manner and preoperatively adjusted to the patient needs with modern CAD/CAM techniques. PATIENTS AND METHODS: The procedure consisted of a CT scan with a simple but unorthodox protocol, 3D modeling of the bone defect and planned prosthesis, finally the preparation of the plate itself. Prostheses were used in the 15 cases of cranial defects. RESULTS: Sample cases were shown with preoperative and postoperative CT scans, patient pictures, and 3D models of the prostheses. The size of the defect ranged from 15 to 95 cm(2), and the observation period after the reconstructive operation ranged from 3 to 23 months. The results were very good in all cases of cranioplasties performed after craniectomies of various origins. CONCLUSION: CAD/CAM shaping gave better adjustment to requirements of specific defect than any standard preformed plate. Such method seemed to be a reasonable alternative to other cranioplastic solutions and can be recommended even for cases of large or complicated shape cranioplasties.

Glioblastoma multiforme and meningioma in the same patient - a case report.

We describe a case of a 64-year-old female who presented with concurrent left parietal glioblastoma multiforme and left occipital parasagittal meningioma. Both lesions were excised during the operation. There was no clinical evidence of phacomatosis. Aetiological and clinical aspects of the phenomenon are discussed.

[The usefulness of fused MRI and SPECT images for the voxel positioning in proton magnetic resonance spectroscopy and planning the biopsy of brain tumors: presentation of the method]. / Przydatnosc obrazów fuzyjnych rezonansu magnetycznego i tomografii emisyjnej pojedynczego fotonu do pozycjonowania obszaru zainteresowania w protonowej spektroskopii rezonansu magnetycznego i planowania biopsji nowotworów mózgu pochodzenia glejowego--prezentacja metody.

BACKGROUND AND PURPOSE: Progress in neurooncology suggests a need to combine information from anatomical-morphological and functional imaging in diagnosis and management. It is not always possible to establish a correct diagnosis using MRI imaging techniques alone, especially in the case of recurrent brain tumors. It is suggested that the results of different imaging techniques should be combined especially in these circumstances. The aim of this study was to evaluate the usefulness of fused post gadolinium MRI and single photon emission tomography (SPECT) images for planning 1H MRS. MATERIALS AND METHODS: 19 patients with a histopathological diagnosis of glial brain neoplasms were examined. SPECT was performed after i.v. administration of iodine-alpha-methyltyrozine (IMT). Fused SPECT and post Gd MR images were obtained on a peripheral console (Linux, PC), using a self developed technique. 1H MRS was performed on a 1.5 T scanner with the single voxel (SVS) technique using STEAM (TE 20 ms, TR 2000 ms) and (PRESS TE 136 TR 2000 ms) sequences. RESULTS: 1H MRS with a volume of interest positioned in the most metabolically active areas on fused images, gave a more accurate diagnosis of tumor type and grade that was clinically relevant in 3 patients. CONCLUSIONS: The authors conclude that planning 1H MRS with the use of fused MRI and SPECT images improves the diagnosis.

[Suprascapular nerve entrapment. A case report]. / Zespól ucisku nerwu nadlopatkowego. Opis przypadku.

We present a case of a 35 year-old man, an office employee, who got ill when working hard building his own house. At the same time shoulder pain and fever occurred, the latter due to the tooth apical abscess. Several months later atrophy of the left supraspinatus and infraspinatus muscles was found. The imaging study (MRI, USG) did not show changes which might affect the suprascapular nerve. Electromyography of the left infraspinatus and supraspinatus muscles revealed fibrillation and positive sharp waves. Distal motor latency to the infraspinatus and supraspinatus muscles, examined by electroneurography, was normal. Mechanical irritation of the spinoglenoid notch is only one of possible mechanisms of the suprascpular nerve impairment in this case. The second is the inflammatory process. Suprascapular nerve impairment does not play an important role in pathogenesis of shoulder pain, but probably it is taken too rarely into consideration in differential diagnosis of shoulder pain.

[Role of proteoglycans and glycosaminoglycans in the intervertebral disc degeneration]. / Rola glikozaminoglikanów i proteoglikanów w procesie degeneracji krazków miedzykregowych.

Proteoglycans and glycosaminoglycans are the main components of the extracellular matrix of the nucleus pulposus. Intervertebral disc degeneration due to aging and excessive mechanical loads results in adverse quantitative and structural changes to the macromolecules. Metalloproteinases induced by inflammatory mediators play a key role in degrading proteoglycans. Progressive matrix breakdown decreases water content in the disc. Dehydration compromises disc cells function and impairs resistance to compression. Biochemical changes may result in disc prolapse. Modifying the metabolism of proteoglycans and glycosaminoglycans might be an effective therapeutic strategy.

[Intraoperative assessment of cognitive and executive functions in patients with brain tumors]. / Sródoperacyjne badanie wybranych funkcji poznawczych i wykonawczych u pacjentów z guzem mózgu.

BACKGROUND AND PURPOSE: The aim of this paper was to evaluate the usefulness of selected methods of intraoperative neuropsychological assessment. In order to investigate the influence of the direct cortical stimulation and tumor resection on the patients' intraoperative performance, we examined selected areas of cerebral cortex involved in cognitive activity in patients undergoing awake craniotomy for brain tumors. MATERIAL AND METHODS: The analyzed group consisted of 21 patients (11 men, 10 women) with tumors located in eloquent areas of the left hemisphere. All patients had intact understanding of speech and relatively minor neurological deficits. We applied both experimental methods as well as certain standardized tests (WAIS-R, AVLT) for the investigation of verbal and nonverbal functions. The tests were performed during direct cortical stimulation and tumor resection, and also before and one week after the operation. RESULTS: Verbal areas were identified in 10 patients, sensorimotor strip in 3, whereas both of them in 3. Even though in 5 out of 21 subjects we were unable to identify the eloquent cortex, there was no difference between pre- and postoperative assessment in these patients. Similarly, there was no statistically significant difference in pre- and postoperative tests among patients with successful cortical mapping. CONCLUSIONS: We showed that the presented methods of intraoperative assessment of cognitive activity were useful and appropriate for the identification of the eloquent areas of the brain.

[Supplementation of cranial defects by an autologous bone flap stored in the abdominal wall]. / Uzupelnianie ubytków kosci pokrywy czaszki autologicznym platem kostnym przechowywanym w powlokach brzucha.

BACKGROUND AND PURPOSE: The aim of this paper is to present an alternative method of cranioplasty with the use of an autologous cranial bone flap stored between primary and restorative surgery in the subcutaneous pocket in the lateral hypogastric region. MATERIAL AND METHODS: Between January 1999 and April 2002, in the Department of Neurosurgery of Medical University of Lódz we performed 36 procedures of the bone flap implantation into the abdominal subcutaneous fat tissue. These procedures followed craniectomy, mainly in cases of acute subdural hematomas and ruptured intracranial aneurysms. RESULTS: After storage, the bone flap was reimplanted in 28 patients. The mean time between operations was 14 days (range 8-53 days). In the cranioplasty group we had only one infection of the bone flap. Among patients excluded from the bone flap restoration we observed one inflammatory complication in the abdominal wall and one subcutaneous hematoma requiring evacuation. CONCLUSIONS: In our opinion, the presented method of the cranial defect's supplementation may be competitive to procedures utilizing synthetic prostheses in the population of patients for whom reimplantation of the bone flap will be expected in 2-3 months after the primary operation. Advantages of the procedure are: the autologous bone graft, the excellent cosmetic effect, low costs of the procedure and low rate of inflammatory complications.

[Hemifacial spasm as an early symptom of posterior fossa meningioma]. / Polowiczy skurcz twarzy jako poczatkowy objaw oponiaka tylnej jamy czaszki.

A rare case of a 47-year old female with hemifacial spasm of the one-year duration as the initial and only symptom of posterior fossa meningioma is reported. At first the patient did not consent to surgery and was unsuccessfully treated with anticonvulsants. A month prior to her admission she started to complain of headache and balance disorder, and developed sensory loss to light touch in II and III branches of the right V nerve. CT revealed a huge posterior fossa meningioma. After a total removal of meningioma, the patient's hemifacial spasm disappeared.

Colloid-like cyst located in the prepontine region.

BACKGROUND: The term "colloid cysts" refers to nonneoplastic lesions located in the anterior part of the third ventricle. However, cysts morphologically identical to colloid cysts are found, albeit extremely rarely, through the neuraxis. CASE DESCRIPTION: We report a case of a 44-year-old man with a short history of headache and 5 years of bilateral hearing loss. Computed tomography (CT) and magnetic resonance imaging (MRI) scans showed an oval lesion located at the anterior surface of the pons. The tumor was excised through a right pterional transsylvian approach. Postoperatively, the hearing deficit remained unchanged. Otherwise, the patient made an excellent recovery. Histopathological examination showed a colloid-like cyst. CONCLUSIONS: Colloid-like cysts growing in the prepontine region are extremely rare. To date, only two similar cases have been reported in the literature. Patients present with headaches, hearing loss, or blurred vision.

[Awake craniotomy and brain mapping for eloquent cortex in patients with supratentorial tumors: a preliminary report]. / Sródoperacyjne wybudzanie i mapowanie elokwentnych okolic mózgu u pacjentów z guzami nadnamiotowymi--doniesienie wstepne.

Malignant brain tumours are incurable at present. Since none of the hitherto used treatment methods allows to significantly extend these patients' survival time, the basic aim is to improve their quality of life. Intraoperative brain mapping seems to be an approach enabling to minimize the risk of irreversible damages to functionally important structures of the brain. In the Department of Neurosurgery of the Medical University of Lódz awake craniotomy with stimulation of eloquent cortex was attempted from May 1999 to July 2000 in 13 patients aged 16 to 77 years. In two patients the attempt of intraoperative awakening was unsuccessful. In 8 out of the 11 awakened patients intraoperative brain mapping had a significant effect on the course of surgery (i.e. on the resection magnitude and "safe corridor"). Out of six patients with tumors situated in the neighbourhood of motor cortex--one developed a severe and permanent paresis of the upper limb. On the grounds of the literature and the authors' own experience an algorithm of awake craniotomy and intraoperative brain mapping was worked out.

[Trigeminal neuralgia due to lengthy AVM treatment. A case report]. / Neuralgia nerwu trójdzielnego po embolizacji wewnatrzczaszkowego oponowego znieksztalcenia tetniczo-zylnego. Opis przypadku.

The authors presented a case of iatrogenic trigeminal neuralgia in a 46-year-old man with a dural arteriovenous malformation (AVM) previously treated by means of intravascular embolization. At first, microvascular decompression (MVD) in the posterior fossa was performed, but unfortunately the pain persisted. Subsequently, percutaneous stereotactic radiofrequency rhizotomy was carried out. The procedure was uneventful and brought about an immediate pain relief.

[Sixteen-year experience in the treatment of trigeminal neuralgia by percutaneous retrogasserian thermorhizotomy]. / Szesnascie lat doswiadczen w leczeniu nerwobólu nerwu trójdzielnego metoda termokoagulacji zwoju Gassera.

The authors present a series of 143 consecutive patients with trigeminal neuralgia who were treated with percutaneous retrogasserian thermorhizotomy between 1984 and 2000. Long time results (follow-up of 16 years) revealed full pain relief in 80% of patients, mainly in those with postoperative sensory deficit, 16% suffered pain recurrence and required additional treatment.

[Use of needle electromyography for diagnosis of radiculopathies]. / Zastosowanie elektromiografii iglowej w diagnostyce zespolów korzeniowych.

Radiculopathy is sometimes evaluated with needle electromyography as additional examination to radiographic imaging. The purpose of this study was to determine the optimal needle electromyography protocol and the use of needle electromyography in the diagnosis of radiculopathy. The authors analysed English language writings from years 1981-2000. The selected studies reported a wide range of needle EMG abnormalities--from about 30 to 100% of pathological EMGs. That is caused by wide variety of patient populations and various EMG protocols. EMG of leg muscles in radiculopathy can consist of the assessment of the spontaneous activity only or be completed with the assessment of motor unit potential (MUP). The EMG of paraspinal muscles assesses spontaneous activity only. The number of abnormalities in needle EMG grows with the presence of characteristic radiculopathy symptoms, but positive EMG examinations are of importance only in cases where diagnosis is complicated. The rate of pathological results is higher when needle electromyography is used in the muscles of paraspinal region and extremities at the same time. The assessment of the spontaneous activity in extremity muscles alone minimizes the influence of error- causing factors on the EMG result. Nevertheless lack of assessment of motor units potentials makes electromyographic investigation of chronic radiculopathy impossible. Sensitivity and specificity of the method have to be determined before the clinical use of the assessment of MUP in chronic radiculopathy, especially in patients without motor weakness. Needle EMG abnormalities correlate with radiological findings in limited range as would be expected from the occurrence of radiological findings in asymptomatic patients and overlapping innervations of myotomes.