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ABSTRACT: Background and purpose: The aim of this retrospective study was to assess the effectiveness of aneurysm clipping by computed tomography angiography (CTA) in a long-term follow-up. Material and methods: The CTA examination was performed in 119 patients who had 143 aneurysms clipped. The exami-na-tions were performed 3 to 11 years (mean 6 years) after clipping using a GE Lightspeed PRO16 scanner. Results: In all cases but one, good quality CTA images, suitable for evaluation of the arteries around the clip site, were obtained. Complete aneurysm closure without neck remnant or regrowth was confirmed in 137 (96%) aneurysms. In 4 (3%) cases, neck remnants were detected (2 on the anterior com-municating artery [AComA] and 2 on the middle cerebral artery [MCA]). A total clip slippage from the aneurysm dome was revealed in 1 case. One case of aneurysm re-rupture was noted, 11 years after clipping. The rebleeding was caused by AComA aneurysm regrowth. Among these 6 pa-tients with unsatisfactory clipping, 2 required further treatment and 4 remain under observation. Nineteen 'de novo' aneurysms in other locations were found in 14 (12%) patients. Summing up all of the pathological findings in the study group, there were 18 (15%) patients who needed further ma-nagement including close surveillance or re-treatment. Conclusions: Computed tomography angiography is a simple and reliable method of aneurysm clipping evaluation. The long- term follow-up CTA confirmed the permanent and complete obliteration of 96% of the aneurysms. The rate of unsatisfac-tory aneurysm closure was 4%, but only 1.4% needed re-treatment during a mean follow-up of 6 years. The annual risk of aneurysm re-rupture was 0.1%.
Neurologia i neurochirurgia polska 01/2013; 47(1):18-26. · 0.43 Impact Factor
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ABSTRACT: The coexistence of schwannoma and meningioma in the same cerebellopontine angle (CPA) is uncommon. Especially, the presence of a single mixed tumour composed of demarcated or intermingled components of schwannoma and meningioma tissue is extremely rare. Such a phenomenon is mainly reported in a patient with NF2 or with history of previous irradiation. We present two cases of simultaneous occurrence of schwannoma and meningioma in the same cerebellopontine angle in young adult patients with clinical manifestation of NF2. The first patient was a 18-year-old young man who presented with bilateral CPA tumours, spinal mass lesion and multiple, small, schwannoma-like lesions of the cauda equina. Both CPA tumours was initially diagnosed as schwannomas based on preoperative MR imagings, however right CPA tumour appeared to be composed of a well-circumscribed transitional meningioma located inside schwannoma of Antoni A and B type. The second patient, a young 16-year-old boy, presented bilaterall CPA tumours as well as many meningeal tumours supratentorially and infratentorially. Two adjacent tumours in the left CPA proved to be schwannoma and meningioma. In both cases, the different neoplastic components were confirmed by histopathological and immunohistochemical studies. The possible mechanism underlying the occurrence of such coexisting tumors of different histogenesis remains unclear.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 01/2012; 50(2):166-72.
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ABSTRACT: Cavernous malformations (CMs) occur in approximately 0.5% of the general population and represent 5-10% of the central nervous system vascular malformations. The majority of CMs appear sporadically but genetically determined familial forms account for 10% to 15% of all cases. The aim of this study was to discuss the clinical, pathological and genetic aspects of familial cerebral cavernous malformations (CCMs). We report on five members of a family who underwent surgery due to CCMs. However, only two members were treated in our Department. The age of onset of symptoms in these cases (4 men and 1 women) ranged from 3 to 28 years. Three members of the family were asymptomatic but it turned out that they were obligatory gene carriers and in one of them the cavernous malformation was confirmed by neuroimaging study. The clinical symptoms of CCMs included seizure (three patients) and focal neurological deficit (two patients). Multiple CCMs were identified in two symptomatic patients (two lesions) and in one asymptomatic patient (three lesions). The lesions were located superficially (4), in the basal ganglia (1), in the brainstem (2) and in the cerebellar vermis (1). In two patients, the subsequent imaging studies showed a single de novo CCM formation. Only one patient with mutation of CCM2 gene was treated surgically. In patients with cavernous malformations the detailed clinical and family history of neurological events ought to be collected. This is particular important in patients with multiple changes or with de novo CCMs formation, identified in subsequent imaging studies. A well-documented family history can help to establish the final diagnosis and makes it possible to offer all members of the family proper neurological and genetic care.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 01/2012; 50(2):152-8.
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ABSTRACT: Background and purpose: The aim of the study was to present our experience in the surgical treatment of intraventricular ependymomas and subependymomas with special consideration to the evaluation of the surgical outcome and risk of tumour recurrence. Material and methods: We report a series of 36 consecutive patients treated surgically for intraventricular ependymoma or subependymoma in the years 1992-2008. There were 26 lateral ventricle and 10 fourth ventricle tumours. Complete resection was achieved in 19 patients while the remaining 17 patients underwent either subtotal or partial resection. Histopathological evaluation revealed ependymoma, subependymoma and anaplastic ependymoma in 20, 11 and 5 cases, respectively. Results: Eight patients died after surgery due to postoperative brain injury. Five patients were severely disabled postoperatively: one patient developed hemiparesis, three patients presented adynamic syndrome, and one patient developed severe cerebellar ataxia subsequent to vermis injury. All patients with posterior fossa tumours presented with lower cranial nerve deficit. Seventeen patients received radiotherapy postoperatively. There were five recurrent tumours during follow-up; three patients underwent subsequent reoperation. Importantly, five patients with supratentorial tumours and a history of incomplete resection with postoperative radiotherapy had no tumour recurrence in over 10 years' follow-up. Conclusions: Intraventricular ependymomas and subependymomas still remain a surgical challenge due to a relatively high incidence of incomplete tumour resections and/or permanent neurological complications associated with their removal. Still, even incomplete tumour removal with subsequent radiotherapy facilitates long-term progression-free survival in some cases.
Neurologia i neurochirurgia polska 01/2012; 46(4):333-343. · 0.43 Impact Factor
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ABSTRACT: Background and purpose: Despite their rarity, post-radiation meningeal tumours seem to be a growing problem due to the increasing application of radiation therapy. The aim of the study was to ascertain the specific features of these tu-mours. Material and methods: Among 433 intracranial meningeal tumours treated from 2000 to 2008, eight cases (2%) have been presumed to be associated with high-dose therapeutic radiation for previous neoplasm of the head (7) or neck (1). On average, tumours were diagnosed 24 years after irradiation. All patients had a solitary meningeal tumour, but two of them also developed other neoplasms in the irradiated area. Results: All tumours were microsurgically removed. The post-operative course was uncomplicated in two cases only. In the remaining 6 (75%), complications included liquorrhoea (2), brain oedema (1), venous thrombosis (1), bleeding into the tu-mour bed (1) and focal deficit due to manipulation (3). Most tumours (5) were WHO grade I meningiomas. These be-nign meningiomas exhibited some peculiar histological features, including focal increase of cellularity, focal enhancement of proliferation index, pleomorphism of nuclei, occasional mitotic figures and, in one case, evidence of brain invasion. One meningioma was assigned to WHO grade II, one to WHO grade III and one appe-ared to be meningeal fi-brosarcoma. The event-free survival and overall survival rate at 4.4 years of follow-up were 63% and 75%, respectively. Conclusions: Radiation-induced tumours of the meninges show certain characteristic histopathological features, which may promote invasiveness of the tumour and higher risk of malignancy.
Neurologia i neurochirurgia polska 01/2012; 46(6):542-552. · 0.43 Impact Factor
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ABSTRACT: Chordomas are rare tumours arising from notochordal remnants. Classical chordomas are generally extradural and, despite benign histopathology, they typically destroy the clivus and surrounding bone structures. Intradural lesions are extremely rare and less than thirty cases of intracranial, exclusively intradural chordomas have been reported so far. The intracranial, intradural but extranotochordal location of chordoma is extremely unique. The authors present a case of chordoma in intracranial location that clinically mimics lateral sphenoid wing meningioma. A previously healthy 39-year-old man was admitted to our Department because of optic disc oedema without neurological deficits. Neuroimaging studies showed a large, contrast-enhanced tumour in the right frontotemporal region that was thought to be a pterional meningioma. The patient underwent successful removal of the tumour. Histopathological study revealed a typical pattern of chordoma, confirmed by immunohistochemical findings. Because of the tumour location the differentiation between chordoma and chordoid meningioma ought to be considered. Such cases, including the present one, may lead to the conclusion that embryonic notochordal remnants may be lost in different places, even away from the neuroaxis.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 01/2012; 50(4):407-12.
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ABSTRACT: Lipidization is observed only occasionally in primary neuroectodermal tumors of the central nervous system. It may reflect lipomatous transformation of tumor cells into xanthomatous and/or adipocyte-like cells. We report a unique case of mixed glioneuronal tumor with marked lipomatous changes in a young patient with intractable epilepsy. MRI revealed a well-circumscribed lesion in the right temporal lobe. Histopathological findings showed the pleomorphic tumor with numerous cells containing large lipid droplets, resembling mature adipocytes, that were arranged in clusters or scattered within the neoplastic tissue. The tumor was composed of both glial and neuronal elements. Some tumor cells displayed features intermediate between glial and neuronal cells. The reticulin fibers were limited to blood vessels. Mitotic figures, vascular proliferation, and necrosis were absent, and MIB-1 labeling index was less than 1%. Diffuse immunoreactivity for GFAP and S100-protein was observed. In some heavily lipidized cells, the lipid droplets were surrounded by a cytoplasmic rim of GFAP immunoreactivity. Numerous cells exhibited immunostaining for NSE and synaptophysin. This is the first documented case of glioneuronal tumor with extensive lipomatous transformation, which might be considered as a heavily lipidized unclassified pleomorphic glioneuronal tumor or a variant of lipoganglioglioma with marked pleomorphism and severe lipidization.
Brain Tumor Pathology 05/2011; 28(3):265-71. · 1.19 Impact Factor
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ABSTRACT: We describe a case of a 52-year-old woman in whom surgery for two tumours located in the cerebellar hemisphere and in the posterior petrous bone was complicated by interruption of the facial nerve (CN VII). During the same procedure, anastomosis of CN VII, using a cable graft harvested from the great auricular nerve, was performed. Seven months later the first signs of reinnervation of the facial muscles were noticed. Two and a half years after surgery, CN VII function was assessed as grade II/III according to the House-Brackmann scale. The authors emphasize the significance of immediate repair of CN VII in modern skull base surgery but also the importance of a patient's self-training to obtain the best functional outcome of the facial reanimation. Reconstruction using the great auricular nerve has two significant advantages: first, the patient avoids further procedures for nerve repair, and second, the harvested nerve is located in direct proximity to the operation area.
Neurologia i neurochirurgia polska 01/2011; 45(5):505-9. · 0.43 Impact Factor
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ABSTRACT: Facial nerve (CN VII) palsy or even its transient paresis causes physical disability but is also a psychosocial problem. Immediately after vestibular schwannoma removal, different degrees of CN VII paresis occur in 20-70% of patients. Facial nerve paresis is observed in 10-40% after surgery of cerebellopontine angle meningiomas. Postoperative facial nerve weakness significantly reduces or completely withdraws with time in the majority of cases. However, even if prognosis for CN VII regeneration is good, proper management is needed because of the potential for serious ophthalmic complications. In this paper, the authors raise the issue of perioperative prophylaxis and comprehensive treatment of postoperative paresis of CN VII. Prophylaxis and treatment of ophthalmic complications are discussed. Current trends in the treatment of intraoperative loss of facial nerve continuity, management of facial paresis with good prognosis and dealing with facial palsy with no spontaneous recovery are also described in the paper.
Neurologia i neurochirurgia polska 01/2011; 45(5):480-8. · 0.43 Impact Factor
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ABSTRACT: BACKGROUND AND PURPOSE : Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. MATERIAL AND METHODS : The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. RESULTS : Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. CONCLUSIONS : In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.
Neurologia i neurochirurgia polska 01/2011; 45(5):452-60. · 0.43 Impact Factor
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ABSTRACT: The authors present the case of a 62-year-old woman with rapid enlargement of a meningioma following radiosurgery (RS). Previous slow growth of the tumor over a 3-year period and the radiological signs of benign meningioma had been confirmed by successive MR scans. Histopathological examination performed after successful surgical removal revealed an atypical, infiltrating meningioma.
British Journal of Neurosurgery 05/2009; 23(2):206-8. · 0.88 Impact Factor
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ABSTRACT: The aim of the study was to find differences in magnetic resonance spectroscopy (MRS) which might facilitate differential diagnosis between tumour regrowth and a remnant tumour with present postradiation changes or postradiation necrosis in the vicinity of the postoperative bed, based on the assessment of the dynamics between two MRS, i.e. preoperative and postoperative scanning, performed at 6 months after surgery. Therefore, in 9 patients with high-grade gliomas, MRS spectra were obtained. Subsequently, a partial tumour resection was done in 5 patients, and 4 subjects underwent a gross total resection. On the second MRS the voxel was placed on an observed contrast enhancement area. The tumour regrowth onset was established by comparing the results of control MRI with postoperative CT scans, and also on the basis of changes in clinical condition as well as a further follow-up, including MRI studies. In patients with tumour regrowth Cho/NAA and Lac/Cr ratios increased and the NAA/Cr ratio decreased between the two MRS studies; in the patients without regrowth, the ratio changes were inverse. In both groups, a decrease in Cho/Cr ratio was observed. In a univariate analysis the presence of tumour regrowth and an increase in Cho/NAA ratio between the two MRS were correlated with a shorter further survival time; a tendency to shorter further survival time was noted with decrease in NAA/Cr ratio. In conclusion, MRS is a diagnostic tool which, on the basis of direction of changes in the value of metabolite ratios, helps additionally confirm the diagnosis of glioma regrowth. In the case of a visible contrast enhancement area on the postoperative MRI with observed concomitant increase in Cho/NAA ratio and decrease in NAA/Cr ratio between pre- and postoperative MRS examinations, preliminary suspicion should be that of glioma regrowth rather than of remnant tumour after surgery or postradiation lesions.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences 02/2009; 47(1):43-9. · 1.23 Impact Factor
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ABSTRACT: To investigate the use of transtympanic electrocochleography (TT-ECochG) analyzed on-line by a detector strategy software that made possible automatic extraction of TT-ECochG components intraoperatively in real-time domain.
Fifteen patients with cerebellopontine angle tumor among 50 patients were included in this study.
All subjects were operated on via middle fossa or retrosigmoid approach. Pure-tone average (PTA) was measured at 0.5, 1.0, and 2.0 kHz, and calculations were performed before and after surgery. Auditory function was monitored intraoperatively via TT-ECochG, and analyzed data were displayed on-line.
TT-ECochG changes in morphology were described. Postoperative PTA elevation level correlated with TT-ECochG morphology changes occurring intraoperatively.
Analyzed on-line, TT-ECochG data were displayed as first negative peak of compound action potential amplitude and latency in time domain every 3 to 5 seconds. A good correlation between postoperative PTA elevation and TT-ECochG morphology changes was showed (Spearman rank test, R = +0.93; t(N-2) = 9.00; p < 0.0001).
TT-EcochG seemed to effectively mirror even minimal changes in auditory function during intraoperative monitoring in real-time domain. Developed strategy of on-line analysis makes the intraoperative hearing status assessment faster and easier.
Ontology & Neurotology 06/2007; 28(4):541-5. · 1.90 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate the use of transtympanic electrocochleography (TT-ECochG) analyzed on-line by a detector strategy software that made possible automatic extraction of TT-ECochG components intraoperatively in real-time domain. PATIENTS: Fifteen patients with cerebellopontine angle tumor among 50 patients were included in this study. INTERVENTION: All subjects were operated on via middle fossa or retrosigmoid approach. Pure-tone average (PTA) was measured at 0.5, 1.0, and 2.0 kHz, and calculations were performed before and after surgery. Auditory function was monitored intraoperatively via TT-ECochG, and analyzed data were displayed on-line. MAIN OUTCOME MEASURES: TT-ECochG changes in morphology were described. Postoperative PTA elevation level correlated with TT-ECochG morphology changes occurring intraoperatively. RESULTS: Analyzed on-line, TT-ECochG data were displayed as first negative peak of compound action potential amplitude and latency in time domain every 3 to 5seconds. A good correlation between postoperative PTA elevation and TT-ECochG morphology changes was showed (Spearman rank test, R = +0.93; t(N-2) = 9.00; p < 0.0001). CONCLUSION: TT-EcochG seemed to effectively mirror even minimal changes in auditory function during intraoperative monitoring in real-time domain. Developed strategy of on-line analysis makes the intraoperative hearing status assessment faster and easier.
Ontology & Neurotology 04/2007; · 1.90 Impact Factor
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ABSTRACT: An isolated, well-differentiated ectopic cerebellum arising outside the posterior fossa is extremely rare. We present a unique case of ectopic cerebellum in 25-year-old woman with hypertelorism, skull deformation, and a longstanding history of epileptic seizures. Magnetic resonance imaging revealed a mass lesion at the base of the frontal lobes with no apparent connections to the adjacent brain structures. Total resection of the lesion was performed. On gross inspection, its surface resembled cerebellar cortex with densely packed folia. Histologically, the cerebellar cortex was composed of well-differentiated external molecular, Purkinje cell, and internal granular cell layers. The deeper part of white matter displayed the features of neuroglial, hamartomatouslike abnormalities. There were numerous neuronal and/or glial heterotopias ranging from single dysplastic neurons to well-circumscribed clusters of neuronal and/or glial cells surrounded by neuropil. Some large neurons looked like mature ganglion cells, Purkinje cells, or dentate neurons. Large irregular islands of heterotopic tissue displaying well-differentiated cerebellar cortex could also be seen. Other parts of the ectopic cerebellum revealed loosening of tissue with dispersed glioneuronal elements. The ectopic brain tissue may arise from disturbed migration of primitive pluripotent stem cells during embryogenesis. The presented case of cerebellar ectopia associated with skull congenital malformations exhibited multiple dysontogenetic abnormalities. To our knowledge, this is the first report of totally isolated, well-differentiated ectopic cerebellum in the anterior cranial fossa accompanied by skull deformation and epilepsy.
American Journal of Surgical Pathology 03/2007; 31(2):322-5. · 4.35 Impact Factor
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ABSTRACT: Hemangioblastomas of the central nervous system are often accompanied by a cyst exhibiting an extensive astroglial reaction. The cyst's wall might be composed of various astroglial elements including reactive pilocytic or gemistocytic and hypertrophic astrocytes. The small tissue samples composed of compact gliotic tissue are sometimes nonrepresentative for primary hemangioblastoma tumour and might be confused with both pilocytic and diffuse infiltrative astrocytoma. Moreover, vascular anomalies of hemangioblastoma-like pattern could be combined with true neoplastic glial proliferation. Such association of glioma with certain types of vascular anomalies has been designated as angioglioma. In the current study we evaluated a series of hemangioblastomas accompanied by advanced astrogliosis of adjacent brain tissue. In some cases the histopathological features of pilocytic gliosis with numerous Rosenthal fibres and eosinophilic granular bodies strongly suggest the diagnosis of pilocytic astrocytoma. One tumour was identified as an angioglioma exhibiting a combination of hemangioblastoma-like tissue and pilocytic astrocytoma. The recognition of such an entity is important in differential tumour diagnosis and prognosis.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences 02/2007; 45(3):120-5. · 1.23 Impact Factor
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ABSTRACT: Some clinical factors have been useful in predicting prognosis in high-grade gliomas, however, unexpected differences in survival time have generated attempts to search for more precise parameters. It is clear that tumour behaviour depends mostly on gene alterations. Known single gene alterations failed to accurately define survival time, however, recently, the gene profiling based on microarray technology has raised hopes. Our aim was to assess whether the genetic predictor exceeds clinical parameters in the prognosis of malignant gliomas. We performed gene expression analysis of 28 gliomas (3 grade II, 10 grade III and 15 grade IV, according to WHO classification), and 5 control, normal brain samples, using Clontech oligonucleotide arrays with 3,757 known genes. The signal-to-noise statistics was used to separate classes, and the leave-one-out method was used to assess the smallest number of genes make it clear with a minimal cross-validation error. All gliomas, or only high-grade tumours, were clearly separated from the normal brain samples using 7 or 9 most differentially expressed genes. Hierarchical clustering failed, but the fuzzy c-means method was useful in high-grade gliomas to find a gene prediction model, which, with clinical factors, was assessed in survival analysis. Univariate analysis demonstrated that age, WHO grade (IV vs. III), radiation dose (> or = 50 Gy vs. 42 Gy), postoperative KPS score (100 points vs. others), neurological deficit as the first sign of the disease vs. others, and gene expression profile were significant predictors of survival. In multivariate analysis, the gene expression profile remained the only independent predictor (p = 0.007). Thus, our conclusion is that gene expression pattern predicts outcome in high-grade gliomas independently of other factors.
International Journal of Oncology 02/2007; 30(1):55-64. · 2.40 Impact Factor
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ABSTRACT: Chordoid meningioma is an uncommon histopathological variant of meningioma with a peculiar chordoma-like appearance. Its association with systemic inflammatory disorder linked to Castleman's syndrome was confirmed in the majority of young patients, however such a relationship in adults remains enigmatic. We report two cases of chordoid meningiomas in adult patients without manifestation of Castleman's syndrome. One tumour was almost totally composed of chordoma-like areas whereas the second one exhibited the unique combination of chordoma- and chondroma-like pattern. This is the first description of chordoid meningioma combined with extensive cartilaginous metaplasia. Both tumours exhibited histological evidence of infiltrative growth, accompanied by a relatively high proliferative index within structures of chordoid appearance. The designation of the chordoid component in meningioma is very important as this subtype of meningioma exhibits a more aggressive biological behaviour and higher risk of recurrence.
Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences 02/2006; 44(1):34-41. · 1.23 Impact Factor
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ABSTRACT: The aim of this study was an analysis of complications after surgical treatment of the cerebral supratentorial arteriovenous malformations (AVM), assessment of their clinical sequelae, and attempt to find factors influencing their occurrence.
88 consecutive patients operated on for AVM in the years 1983-2000 were included in a retrospective study. In all patients microsurgical, selective removal of AVM was performed, without prior embolization. The statistical analysis was carried out by means of exact Fisher test and c2 test.
Complications in the postoperative period were observed in 45.5%, including short-term deterioration (27.3%) and symptoms present till the day of discharge (18.2%). Mechanisms of deterioration were as follows: significant intraoperative hemorrhage (5.7%), hemodynamic disturbances after AVM removal (20.5%) and resection of AVM in the eloquent area (19.3%). Many variables that may contribute to the complications were studied. Factors increasing the risk of significant intraoperative hemorrhage are: steal effect visible in angiography (32% vs. 10%, p<0.05), intraventricular penetration of AVM (38% vs. 11%, p<0.05). Factors increasing the risk of hemodynamic disturbances are: feeding from the medial cerebral artery (MCA) (31% vs. 8%, p=0.02) and complex venous drainage (32% vs. 14%, p=0.05).
The most common causes of postoperative deterioration are hemodynamic disturbances after AVM removal and manipulation in the eloquent area. Hemodynamic disturbances worsened the prognosis significantly, and were the only cause of mortality (3.4%). However, massive intraoperative hemorrhage and operation in the eloquent area did not influence the outcome significantly. Risk factors for intraoperative hemorrhage are steal effect and intraventricular penetration of AVM. Risk factors for hemodynamic disturbances are feeding AVM from MCA and complex venous drainage.
Neurologia i neurochirurgia polska 01/2006; 40(2):98-105. · 0.43 Impact Factor
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ABSTRACT: Sudden deafness (SD) is thought to be a heterogenic group of disorders as to etiopathogenesis. Acoustic neuroma should always be considered in the differential diagnosis. The authors analysed symptoms occurring in the group of 89 patients, diagnosed with acoustic neuroma. A special attention was paid to the role of sudden deafness as a clinical manifestation of the VIIIth nerve pathology. Progressive hearing loss, tinnitus, headache and sudden deafness were the most common complaints. Sudden deafness was developed by approximately 1 of the investigated patients (24.7%). Progressive hearing loss, tinnitus and sudden deafness were also dominating initial signs. The sudden deafness onset was preceded by the period of progressive hearing loss in 3 patients. In one case episode of SD occurred twice.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 10/2005; 19(111):307-8.
