Paweł Nauman

Jagiellonian University, Cracovia, Lesser Poland Voivodeship, Poland

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Publications (35)50.23 Total impact

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    ABSTRACT: Objectives: Intracranial aneurysms (IAs) of the posterior circulation (PC) rupture more frequently and their morbidity and mortality rates are higher compared to anterior circulation. Morphological parameters such as size ratio (SR), inflow angle and parent artery geometry are believed to contribute significantly in determining IA risk rupture. The aim of this study is to establish angiography-based morphometric predictors of PC IA risk rupture. Methods: A retrospective analysis of 58 patients with PC aneurysms was incorporated into the study. The following independent variables were measured: aneurysm dome size, neck size, parent artery size, SR, neck to parent artery ratio, and inflow angle. All aneurysms were divided into ruptured and unruptured groups. The stepwise logistic regression analysis was applied to establish the predictors of PC aneurysm risk rupture. Results: 58 patients with 27 unruptured and 31 ruptured PC cerebral aneurysms were analyzed. The mean aneurysm dome, neck and parent vessel diameters were 8·49±3·5 mm, 2·46±1·4 mm, and 3·92±1·6 mm, respectively. Size ratio was 2·26±0·6; dome/neck 3·45±0·8 and inflow angle 115·2±22°. The relevant difference between unruptured and ruptured groups was: SR (1·91 vs 2·48), aneurysm dome (7·96 vs 8·95 mm), dome/neck (3·77 vs 3·18), and inflow angle (103·7 vs 125·2°). The significant predictive value was reached for inflow angle (OR 1·05; Cl 95% 1·01 to 1·1) and SR (OR 3·53; Cl 95% 1·09 to 11·5). Cut-off value on receiver operating characteristic curve for inflow angle (113·1°; sensitivity 67·7% and specificity 81·5%) and SR (1·99; sensitivity 77·4% and specificity 63%). Discussion: The SR and inflow angle proved to be relevant predictors in estimating the aneurysm risk rupture of the posterior cerebral circulation.
    Neurological Research 01/2014; · 1.45 Impact Factor
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    Parkinsonism & Related Disorders 09/2013; · 4.13 Impact Factor
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    ABSTRACT: Abnormalities in pain perception are a part of the clinical picture in Parkinson's disease (PD) and belong to the category of non-motor symptoms. Two groups of patients were included in this study: (i) an experimental group of 36 patients with PD who were eligible for subthalamic deep brain stimulation (the experimental group [EG]) and (ii) a control group (CG) of 34 patients with a space-occupying lesion who were admitted for a framed stereotactic biopsy. Stereotactic frame fixation was used in both groups as a nociceptive stimulus. All participants were assessed for pain perception with two kinds of visual analogue scales (VAS) (a non-color VAS [ncVAS] and a color VAS [cVAS]) immediately after the stimulus (EG - ncVAS 1 and cVAS 1; CG - ncVAS 3 and cVAS 3) and 24 hours later (EG - ncVAS 2 and cVAS 2; CG - ncVAS 4 and cVAS 4). The means for the two pain scores assessed directly after frame fixation were 3.59 (ncVAS 1) and 3.06 (cVAS 1) for patients in the EG, while the mean ncVAS was 3, and the mean cVAS 3 was 6.1 for those in the CG. The pain intensity was significantly lower for patients with PD (EG) compared to those in the CG for both ncVAS and cVAS (p<0.05 for each measure). The mean pain scores for ncVAS and cVAS measured 24hours after the procedure were 3.18 and 2.79 for patients with PD (EG) and 6.10 and 5.77 for those in the CG, respectively. Pain intensity measured 24hours after the procedure was significantly lower in those with PD (EG) compared to the CG. This study has demonstrated that pain perception in patients with PD is significantly lower than pain perception in non-parkinsonian patients.
    Journal of Clinical Neuroscience 02/2013; · 1.32 Impact Factor
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    ABSTRACT: To assess the correlation between quality of life (QoL), depressive symptoms and motor signs in patients with Parkinson disease after subthalamic deep brain stimulation (DBS STN). MATERIAL and 74 patients, average age 55.6 ± 7 and duration of disease 12.3 years± 3.8, treated with l STN DBS for PD were included in the study. All patients were evaluated with (UPDRS III), (PDQ-39) (BDI) at baseline and at 6, 12, and 24-month follow up. All patients were also stratified into three groups depending on UPDRS III improvement ( < 30%, 30-60%, > 60%). Scores in all scales significantly decreased from baseline. The improvement in PDQ-39 was 43.3%, in BDI 25.3 %; UPDRS-III 55.5% at 6 months. At 24 months, motor results and QoL deteriorated by 15.6% and 19.6% respectively. BDI remained unchanged. Mean scores at baseline in PDQ-39 were group I 67.4 ± 29.7; II 64.8±32.0; III 53.4±22.0 and for BDI, group I 17.4±12.04; II 14.0±9.7; III- 15.1±10.55. Scores decreased significantly with DBS at 6-month follow-up and mean change was: PDQ-39, group I 42.7%, II- 40.7%, III 51.6%; BDI group I 23%, II 28.1%, III 23.3 %. Reduction of depressive symptoms, motor signs and improvement of QoL in PD after DBS STN are closely related. Improvement of QoL depends significantly on motor symptoms.
    Turkish neurosurgery 01/2013; 23(3):379-84. · 0.53 Impact Factor
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    ABSTRACT: Complete aneurysm obliteration reduces the risk of rebleeding and is an important goal of the aneurysm treatment. MATERIAL and A retrospective analysis of 63 patients undergoing endovascular treatment of posterior circulation aneurysms. The occlusion rate was stratified to three groups: complete, incomplete and partial. In the analysis compared the influence of the selected characteristics: age, sex, WFNS grade, aneurysm location, size of the aneurysm dome and neck, neck to dome ratio, on the effectiveness of embolization in each group. A multi-factor analysis with probit model and linear regression was applied to assess the impact of all characteristics on the complete occlusion. In the series of 63 single aneurysms, 51 were ruptured and 12 unruptured aneurysms. Complete occlusion was achieved in 36 (57.1%), incomplete in 15 (23.8%), partial in 12 (19%) patients. In patients with the neck size of 1-2 mm the complete occlusion was in 75% (24/32) incomplete in 12,5% (4/32), while when the neck size was 2-4 mm these rates were 38.7% (12/31) and 29% (9/31) respectively. The predictor of total occlusion in probit and linear regression model was only one independent variable, the narrow-neck size. Multi-factor analysis found that the strongest predictor of the complete occlusion is the aneurysm neck size.
    Turkish neurosurgery 01/2013; 23(1):25-30. · 0.53 Impact Factor
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    ABSTRACT: Background: Microlesion effect (MLE) is a commonly observed phenomenon after electrode insertion into the subthalamic nucleus (STN) for deep brain stimulation (DBS). Objectives: The aim of this study was to determine the presence of the MLE in the early postoperative period and the relationship between MLE and STN DBS. Methods: 74 patients with Parkinson's disease were included in this study. Motor symptoms were evaluated preoperatively, within 48 h after electrode implantation and at 6 months with United Parkinson's Disease Rating Scale part III (UPDRS-III). According to the improvement level with MLE, all participants were stratified into three groups: (1) less than 20%; (2) 20-40%, and (3) more than 40% in OFF medication states. The degree of improvement in UPDRS-III with DBS ON for each MLE group was assessed at the 6-month follow-up. Regression analysis was applied for the evaluation of the relationship between MLE and improvement with DBS ON. Results: Mean results in UPDRS-III with the MLE in ON and OFF medication states were 22.1 ± 10.5 and 42.1 ± 14 points, respectively. At the 6-month follow-up, with active stimulation, results tended to further ameliorate to 14.6 (59.4%) points in ON and 20.8 (55.3%) in OFF. Mean improvement in MLE groups were: 33.6% group 1, 47.5% group 2 and 61.4% group 3. Regression analysis revealed a positive correlation between the MLE and results at 6 months with DBS ON. Conclusion: Results proved the presence of MLE in the early postoperative period. Furthermore, a positive correlation between MLE and improvement degree with active stimulation was observed.
    Stereotactic and Functional Neurosurgery 11/2012; 91(1):12-17. · 1.46 Impact Factor
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    ABSTRACT: Deep brain stimulation (DBS) is a method of treatment utilized to control medically refractory epilepsy (RE). Patients with medically refractory epilepsy who do not achieve satisfactory control of seizures with pharmacological treatment or surgical resection of the epileptic focus and those who do not qualify for surgery could benefit from DBS. The most frequently used stereotactic targets for DBS are the anterior thalamic nucleus, subthalamic nucleus, central-medial thalamic nucleus, hippocampus, amygdala and cerebellum. The DBS is believed to be an effective method of treatment for various types of epilepsy among adults and adolescents. Side effects may be associated with implantation of electrodes and with the stimulation itself. An increasing number of publications and growing interest in DBS application for RE may result in standardization of the qualification and treatment protocol for RE with DBS.
    Archives of Medical Science 11/2012; 8(5):805-16. · 1.89 Impact Factor
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    ABSTRACT: Extent of resection plays a key role in the treatment of malignant gliomas (MGs). Patients with complete glioma removal, followed by chemoradiation, obtain the longest overall and progression-free survival. Fluorescence-guided resection of MGs enables intraoperative visualization of glioma tissue and increases control of the resection. The authors present preliminary results of 5-aminolevulinic acid (5-ALA) application during the resection of primary and recurrent MGs. Six patients with either a suspected malignant glioma based on magnetic resonance imaging (MRI) or with recurrent glioblastoma multiforme were enrolled in the study. The extent of resection was calculated according to the postoperative MRI performed within 72 hours. Preoperative and early postoperative neurological status and Karnofsky Performance Scale (KPS) were compared. Fluorescence of tumour tissue was observed in 5/6 patients (five with the histopathological diagnosis of glioblastoma multiforme and one with neurotoxoplasmosis and AIDS). Complete tumour resection was achieved in 5 patients. Postoperative KPS and neurological status deteriorated in 2 cases. Radiotherapy and chemotherapy did not interfere with the sensitivity of the fluorescence guided tumour visualization. Fluorescence-guided resection of primary and recurrent MGs with 5-ALA improves control of the tumour resection. It enables the cytoreduction to be maximized but experience in neuro-oncological surgery is required to avoid serious, postoperative neurological deficits.
    Neurologia i neurochirurgia polska 01/2012; 46(1):47-51. · 0.54 Impact Factor
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    ABSTRACT: We present two cases (female and male patients, aged 64 and 38, respectively) of focal mass lesions mimicking a brain tumour: one with cognitive function deficit, memory troubles, behavioral changes and left hemiparesis, the other with difficulty in orientation and right hemiparesis. General physical and neurological examinations, laboratory tests and neuroimaging were used to diagnose the cases. Both of them showed nonspecific changes in the brain tissue and the brain tumour was suspected. In the first case MRI scan revealed two pathological masses in the right frontal region and hemorrhagical focus with destructions inside lesions. Second patient's MRI scan revealed a pathological mass at the interface of the left temporal and occipital regions. The neurosurgical procedure was performed. The final diagnosis was established on the basis of neuropathological examination of postoperative material. On light microscopy examination a severe cerebral amyloid angiopathy (CAA) was revealed. Amyloidoma was excluded due to the absence of amorphous material and eosynophylic masses. Tumefactive CAA is a rare condition. These two cases of focal, tumefactive, masslike lesions of diffuse cerebral amyloid angiopathy are reported because of diagnostic dilemmas. In patients with history of memory disfunction, neurological deterioration and different multiple changes observed in CT and MRI scans, such as hemorrhagic infarcts and ischemic cerebral lesions, CAA should be suspected. The imaging findings make a distinction between tumefactive CAA and brain tumours like gliomas difficult. A differential diagnosis of CAA and amyloidoma plays a significant role in a neuropathological examination.
    Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 01/2012; 50(2):194-200.
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    ABSTRACT: Background and purpose: Quantitative and qualitative analysis of neurosurgical procedures provides important data for assessment of the development and trends in the field of neurosurgery. The authors present statistical data on intracranial procedures (IPs) performed in Poland in 2008-2009. Material and methods: Data on IPs come from reports of the National Health Fund, grouped according to the system of Diagnosis-Related Groups, group A - nervous system diseases. Data concerning the year 2009 include all IPs performed in Poland. Data from the second half of 2008 to 2009 (18 months) come from 35 neurosurgical centers in Poland, divided by provinces. We analyzed the number of IPs, the cost of procedures, duration of hospitalization and deaths. Results: 20 849 IPs were performed in Poland in 2009. The most common procedure was A12 (6807; 32.65%), and the rarest was A04 (96; 0.46%). The annual cost of all IPs was 228 599 956 PLN. Average cost of the procedure ranged from 1578 PLN (A14) to 47 940 PLN (A03). Duration of the hospitalization ranged between 3 days (A14) and 12 days (A12). The highest percentage of deaths was reported for A01 (n = 1050, 19.06%). Reports from 35 neurosurgical centers in the second half of 2008 and 2009 showed the highest number of IPs per 100 000 population in Kujawsko-Pomorskie (93) and the lowest in Wielkopolskie (27) and Podkarpackie (27). The highest number of IPs (1669) was performed in neurosurgical center M1 (Małopolskie), and the lowest (99) in W1 (Wielkopolskie). Conclusions: A significant disparity in the number of IPs performed in different centers in Poland was observed.
    Neurologia i neurochirurgia polska 01/2012; 46(4):326-332. · 0.54 Impact Factor
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    ABSTRACT: Background and purpose: Despite the rapid development of neuropharmacotherapy, medical treatment of neuropathic pain (NP) still constitutes a significant socioeconomic problem. The authors herein present a group of patients treated with motor cortex stimulation (MCS) for NP of various types and aetiologies. Material and methods: Our cohort included 12 female and 11 male NP patients aged 53 ± 16 treated with MCS. Eleven patients were diagnosed with neuropathic facial pain (NFP), 8 with hemi-body neuropathic pain (HNP), and 4 with deafferentation pain (DP). Prior to surgery, 16 out of 23 patients were treated with repetitive transcranial magnetic stimulation (rTMS), with a positive response in 10 cases. Pain intensity in our group was evaluated with the visual analogue scale (VAS) one month before and three months after MCS im antation. Results: Improvement on the VAS was reported in the whole group of patients (p < 0.001). The best results were reported in the NFP group (p < 0.001) while the worst ones were noted in the DP group (p = 0.04). Anamnesis duration positively correlated with outcome. Infection forced the authors to permanently remove the system in one case. There were no other complications in the group. Conclusions: Minimally invasive, safe neuromodulative treatment with MCS permits neuropathic pain control with good efficacy. The type of neuropathic pain might be a prognostic factor.
    Neurologia i neurochirurgia polska 01/2012; 46(5):428-435. · 0.54 Impact Factor
  • Parkinsonism & Related Disorders 01/2012; 18:S141. · 4.13 Impact Factor
  • T. Mandat, H. Koziara, T. Tykocki, B. Krolicki, B. Brodacki, T. Kmiec, D. Koziorowski, P. Nauman, R. Rola, W. Bonicki
    Parkinsonism & Related Disorders 01/2012; 18:S67. · 4.13 Impact Factor
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    Tomasz Tykocki, Tomasz Mandat, Paweł Nauman
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    ABSTRACT: Postural instability and gait difficulty (PIGD) are commonly observed in advanced Parkinson's disease. The neuronal mechanism of PIGD is not fully understood. Dysfunction of the pedunculopontine nucleus (PPN) might be a possible cause of these symptoms. The autopsy studies of subjects with PIGD revealed a neurodegenerative process involving mainly PPN cholinergic neurons. The PPN participates in the locomotion processes by initiation, modulation and execution of stereotyped patterns of movement. The standard neurosurgical treatment of PD is subthalamic deep brain stimulation (STN DBS). Clinical results revealed low efficiency of STN DBS on PIGD. Preliminary results of simultaneous PPN and STN DBS are very promising. Only a few reports have been published until now; a significant improvement of PIGD was observed in both ON and OFF L-dopa states.
    Archives of Medical Science 08/2011; 7(4):555-64. · 1.89 Impact Factor
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    ABSTRACT: Quality of life can be severely impaired by essential tremor (ET) being the main cause of the patient's disability. The authors present a group of ET patients treated with deep brain stimulation of the ventral intermediate nucleus of the thalamus (Vim DBS). The aim of the study was to evaluate the efficacy and safety of Vim DBS in the treatment of ET. Between 2006 and 2009, 8 female and 10 male ET patients were treated with Vim DBS. Mean age at implantation was 63 ± 15 years. ET lasted from 4 to 30 years (mean 12 years). Clinical condition of the group was evaluated before surgery and 3 months after implantation with spirography (spiral drawings), the modified Fahn (Tremor Rating Scale, TRS) scale, and the modified ADL (Activity of Daily Living) scale. The Vim was localized with CT and MRI. The procedures of implantation were performed under local and general anaesthesia. A bilateral procedure was performed in 11 cases and a unilateral procedure was performed in 7 cases. The therapeutic effect of DBS was maintained at the follow-up in the third month following surgery. Mean contralateral limb tremor reduction was 79%. Head tremor reduction was reported by 75% of patients in the bilateral Vim DBS subgroup and 50% of patients in the unilateral Vim DBS subgroup. Mean ADL score improved by 61%. Vim DBS is a safe and effective method of ET treatment. Vim DBS improves activities of daily living of ET patients.
    Neurologia i neurochirurgia polska 01/2011; 45(1):37-41. · 0.54 Impact Factor
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    ABSTRACT: Papillary tumour of the pineal region (PTPR) is a rare neoplasm that has been formally included in the 2007 WHO classification of central nervous system tumours. The critical diagnosis of this neoplasm is often difficult because of its similarity to other primary or secondary papillary lesions of the pineal region, including parenchymal pineal tumours, papillary ependymoma, papillary meningioma, choroid plexus papilloma and metastatic papillary carcinoma. We present the variability of the histopathological pattern in three cases of PTPR. All cases showed predominant epithelial-like morphology but with various degrees of papillary formation and intensity of cellular pleomorphism. One tumour was highly cystic and exhibited cellular sheets containing vessels covered by several layers of uniform columnar to cuboidal tumour cells. The second tumour showed distinct papillae covered by layers of polymorphous cells with atypical, often hyperchromatic nuclei. Numerous cells displayed foamy, eosinophilic or clear, sometimes vacuolated cytoplasm. The third case consisted of solid cellular areas composed of pseudostratified columnar cells, most often arranged in perivascular pseudorosette formations. The cells lining papillary structures exhibited marked polymorphism with atypical, often plump nuclei. Mitotic figures were rare and areas of necrosis were observed only in one case. Immunohistochemical staining showed diffuse immunoreactivity for neuron-specific enolase, S-100 protein, cyto-keratin and vimentin. Focal reaction for synaptophysin and chromogranin A and epithelial membrane antigen (EMA) were observed. The tumours lacked expression of GFAP. The Ki-67 labelling index was relatively low but its focal increase was noted in two cases. The final diagnosis of PTPR was based on both predominant papillary morphology and immunohistochemical results. PTPR should be considered in diagnosis of pineal tumours but their natural history, therapeutic strategy and prognosis remain controversial.
    Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 01/2011; 49(3):181-90.
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    ABSTRACT: BACKGROUND AND PURPOSE : Due to the complex and extended cerebral organization of language functions, the brain regions crucial for speech and language, i.e. eloquent areas, have to be affected by neurooncological surgery. One of the techniques that may be helpful in pre-operative planning of the extent of tumour removal and estimating possible complications seems to be functional magnetic resonance imaging (fMRI). The aim of the study was to develop valid procedures for neuropsychological assessment of various language functions visualisable by fMRI in healthy individuals. In this fMRI study, 10 healthy (with no CNS pathology), right-handed volunteers aged 25-35 were examined using four tasks designed to measure different language functions, and one for short-term memory assessment. A 1.5-T MRI scanner performing ultrafast functional (EPI) sequences with 4-mm slice thickness and 1-mm interslice gap was used to detect the BOLD response to stimuli present-ed in a block design (30-second alternating blocks of activity and rest). The analyses used the SPM software running in a MATLAB environment, and the obtained data were interpreted by means of colour-coded maps superimposed on structural brain scans. For each of the tasks developed for particular language functions, a different area of increased neuronal activity was found. The differential localization of function-related neuronal activity seems interesting and the research worth continuing, since verbal communication failure may result from impairment of any of various language functions, and studies reported in the literature seem to focus on verbal expression only.
    Neurologia i neurochirurgia polska 01/2011; 45(6):567-76. · 0.54 Impact Factor
  • Tomasz Tykocki, Paweł Nauman, Tomasz Mandat
    Neurologia i neurochirurgia polska 01/2011; 45(1):57-62. · 0.54 Impact Factor
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    ABSTRACT: The role of subthalamic nucleus deep brain stimulation (STN DBS) in the treatment of Parkinson disease (PD) is well established. The authors present a group of patients diagnosed with PD who were treated with STN DBS. Between 2008 and 2009, 32 female and 34 male patients with PD were treated with STN DBS. Mean age at implantation was 57 ± 12 years. PD lasted from 6 to 21 years (mean 10 years). Patients were qualified for the surgery according to the CAPSIT-PD criteria. The STN was identified with direct and indirect methods. Macrostimulation and microrecording for STN identification were used in all cases. A unilateral STN DBS system was implanted in two cases and bilateral implantation was performed among rest of the group. Outcome was assessed six months after implantation. Results : The mean reduction of UPDRS III score among 51 patients who underwent follow-up was 45% (5-89%). Reduction of levodopa consumption varied from 15 to 100%. Infection forced the authors to remove the DBS system in one case four months after implantation. Skin erosion above the internal pulse generator was noted in four cases. Cardinal symptoms of Parkinson's disease can be safely and effectively treated with STN DBS in selected group of patients.
    Neurologia i neurochirurgia polska 01/2011; 45(1):32-6. · 0.54 Impact Factor
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    ABSTRACT: A group of 37 patients diagnosed with Parkinson’s disease (PD) were treated with subthalamic deep brain stimulation (STN DBS). The mean age at implantation was 59±11 years and PD has been present from 6 to 17 years (mean 9). The STN was identified by direct and indirect methods: macro stimulation and microrecording in all cases. At a three month follow-up, the authors observed a mean reduction of 49% in UPDRS II score and a mean reduction of 65% in UPDRS III score. Mean reduction of l-dopa consumption was 62%. The authors concluded that STN DBS safely reduces disabling symptoms of PD.
    Biocybernetics and Biomedical Engineering 01/2011; 31(3):47–55. · 0.16 Impact Factor

Publication Stats

84 Citations
50.23 Total Impact Points

Institutions

  • 2013
    • Jagiellonian University
      • Department of Neurology
      Cracovia, Lesser Poland Voivodeship, Poland
  • 2012
    • Centrum Onkologii-Instytutu
      Warszawa, Masovian Voivodeship, Poland
  • 2010–2012
    • Institute of Psychiatry and Neurology
      Warszawa, Masovian Voivodeship, Poland
  • 2011
    • Maria Skłodowska-Curie Institute of Oncology
      Cracovia, Lesser Poland Voivodeship, Poland
  • 2004–2011
    • Polish Academy of Sciences
      • • Zakład Neuropatologii Doświadczalnej i Klinicznej
      • • Zespół Kliniczno - Badawczy Neurochirurgii
      Warsaw, Masovian Voivodeship, Poland