Juraj Steno

Comenius University Bratislava · Department of Neurosurgery

Background The questions of whether the spatial resolution of navigated 3D-ultrasound (3D-US) power-Doppler angiography imaging rendered by existing 3D-US systems is sufficient for the intraoperative visualization of cerebral aneurysms, and in what percentage of cases, are largely unanswered. A study on this topic is lacking in the literature. Met...

Inflammation and immunity belong to the main factors influencing tumor growth. In this study, we attempted to identify a profile of biomarkers associated with gliomas. We found decreased serum levels of sTREM-1 (soluble triggering receptor expressed on myelocytes) and increased levels of IL-10 in all grades of glioma patients in comparison with hea...

HLA-G is an immune checkpoint molecule with immunosuppressive and anti-inflammatory activities, and its expression and level of its soluble form (sHLA-G) may play an important role in tumor prognosis. The HLA-G 14bp ins/del polymorphism and the plasma level of soluble HLA-G (sHLA-G) were investigated by a polymerase chain reaction and ELISA, respec...

•Preservation of LSAs is extremely important during resections of insular gliomas.•Navigated 3D-US power Doppler may enable intraoperative visualization of LSAs.•Quality of ultrasound scanner is important when LSAs should be visualized.•Reliability of LSAs depiction by 3D-US power Doppler is still investigated.

HLA-G is an immune checkpoint molecule with immunosuppressive and anti-inflammatory activities, and its expression and level of its soluble form (sHLA-G) may play an important role in tumor prognosis. The HLA-G 14 bp ins/del polymorphism and the plasma level of soluble HLA-G (sHLA-G) were investigated by a polymerase chain reaction and ELISA, respe...

Background: Human leukocyte antigen G (HLA-G) belongs to non-classical MHC class I molecules that is involved in the suppression of immune response. As HLA-G plays important role in the maintenance of fetal tolerance, its overexpression has been associated with tumor progression. For the regulation of HLA-G levels, genetic variants within the 5′ up...

While benefits of neurosurgical intraoperative ultrasound (IOUS) are reported frequently, this method still has some significant pitfalls, which are described less often. However, sufficient knowledge on dealing with IOUS drawbacks, particularly various image artifacts, is important for successful surgery. We report a case of failed IOUS-guided ped...

Introduction: Anti-inflammatory effect of vitamin D (VD) could be beneficial in improving the survival of glioma patients. The aim of our study was to analyse the serum levels of vitamin D in glioma patients and to find an association with the prognosis of glioma patients and other investigated parameters. Material and methods: The study include...

Objectives: Evaluation of the impact of surgical treatment on malignant transformation (MT) of adult supratentorial infiltrative grade II gliomas (G2G) in a series of chemotherapy and radiotherapy-naïve patients. Background: Despite G2G are slow-growing tumours, they typically undergo MT with a subsequent fatal disease course. An extensive resec...

Objective: In recent years, the role of the modern inflammatory markers TREM-1 (triggering receptors expressed on myeloid cells) and HMGB1 (high mobility group box 1 protein) in tumorigenesis has begun to be studied. Their role in gliomas is not clear. The aim of our study was to find the role of inflammation in gliomas. Patients and Methods. In 6...

The communicating branches of the spinal nerve roots influence the innervation area covered by the brachial plexus so can give the confusing clinical picture, if damaged.

Neurosurgery deals especially with the neuroanatomical structures. Their terminology is adjusted according to the latest issue of the Terminologia Neuroanatomica (a part of the standard anatomical terminology), which should be accessed free via their web link. The terminological authorities propose also the terms of newly introduced neuroanatomical...

The cervical spinal roots give origin to the cervical and brachial plexuses, so their interconnections can influence the innervation areas of the terminal branches of these plexuses.

Explains the types of neuropathies.

The lower limbs receive the innervation mainly through the lumbar and sacral plexuses. Communicating branches and anomalies of their spinal nerve roots can confuse the correct diagnosis, if damaged.

The main purpose of this book is to provide the reader with a better understanding of spinal nerve root injuries caused by various pathologies (e.g. disc herniation, space-occupying lesions, trauma etc.). The standard anatomical description of spinal nerve roots origin, course and arrangement (described in the first chapters of the book) is now str...

The general anatomical pattern of the sensory and motor innervation areas should be influenced by the variable embryonic development of the individual and hence changed. Overlapping areas of the specified regions are described.

This chapter provides the normal spinal cord anatomy along with the description of the origins and structure of the normal spinal nerves and their surroundings. Some peculiarities of the transitional zone between CNS and PNS are also given.

Some variability in certain dimensions, form, structure, and position is natural for the human body and internal organs. Simply said, it is tolerated and part of natural variability.

Over the past 80 years were reported the study results observing various spinal nerve root anomalies found both intraduraly and also extraduraly. Majority of them were focused to the exposed lumbosacral region.

Connections between the ventral and dorsal rootlets of the lumbosacral plexus have a complex structure, including also a possible doubling of the spinal ganglia.

The various types of peripheral nerve injuries are discussed from the neurosurgical point of view including the reconstruction possibilities and their possible consequences.

The chapter describes our results obtained from the cadaverous study (on 43 specimens). Found nerve root anomalies are classified according to the plexus type and localization (intradural or extradural). The results are compared with the results of other authors. The pictures of specified variations are showed, and clinical impact is discussed.

The communicating branches should be seen not only between nerve roots but also within one nerve (between fascicles). This fact makes its possible reconstruction more difficult.

Exposed lumbosacral region and its extradural spinal nerve root anomalous anatomy are often the subject of focused attention of many authors. The study results favour those realized on the cadaverous material. Several classifications were proposed aimed on the systemizing the found lumbosacral variations, we suggest also one. Anomalous lumbosacral...

Extradural spinal nerve root anomalies include several possibilities.

Description of the vertebral column standard anatomy and spinal nerve exits with some possible influencing changes.

The lumbosacral region is mostly exposed due to the frequent incidence of the intervertebral disc hernia and its surgery. Spinal dorsal root interconnections can influence the clinical signs and also the surgical treatment of this symptom.

Axonal regeneration and possible neurosurgical reconstruction are described; some nerve suture types are shown.

Objectives: Neurenteric cysts (NCs) of the central nervous system (CNS) are cystic congenital lesions that may occur anywhere along the neural tube. They are most common in the spinal region, in the lower part of the cervical and upper thoracic spine. Intracranial NCs occur rarely and there are only small series of patients published in literature...

THE AIM of this work is to point out the intraspinal anatomical current occurrence interconnections between intradural and extradural nerve roots and their possible participation in radiculopathy. Methods: The anatomical study was performed in 43 cadavers with a mean age of 53.7. All intradural and extradural rami communicantes between nerve root...

An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture.Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. Anterior approach was used in 15 of them, both posterior and anterior approaches were used in five of them. The prefixed type plexus...

Background: Primary intracranial germ cell tumors represent a rare category of neoplasms, which occur in children and young adults. The WHO classification divides intracranial tumors into germinomas and non-germinomas. The most frequent locality of these tumors is pineal and suprasellar region. Clinical signs and symptoms depend on the localizatio...

Intracranial aneurysm is a fairly common (often asymptomatic) condition. Subarachnoid hemorrhage associated with aneurysmal rupture is a potentially lethal event with a mortality rate as high as 50 percent and a high rate of disability among those who survive the initial hemorrhage, such that recently published guidelines support treatment of intra...

Traditionally, astrocytes are divided into fibrous and protoplasmic types based on their morphologic appearance. Here the cultures were prepared separately from the adult human cortical gray and white matter of brain biopsies. Both cultures differed only in the number of glial fibrillary acidic protein (GFAP)-positive cells. In the gray matter thes...

Radiation to the brain and adjuvant chemotherapy may produce late delayed changes from several months to years after treatment of intracranial malignancies with a reported prevalence of 5-24%. The pattern of treatment-related injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions. Differentiation of treatme...

Presented is the analysis of patients who underwent external beam radiotherapy (EBRT) to the brain in the period from 2003 to 2006 at the department of Radiation Oncology of the St. Elisabeth Cancer Institute. The aim of our analysis was to identify risk factors of late delayed therapy induced injuries (LDTI) in the brain. The patients were regular...

The nerve structures which make up the walls of the third cerebral ventricle provide for important functions, in particular maintaining homeostasis, memory mechanisms and visual functions. Their gradual impairment by tumour can be compensated for various time periods. When the tumour clinically manifests, it may already be of significant extend, or...

Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the third ventricular floor that has an unclear pathogenesis. In all 7 previously described cases, PEIR was present in adult patients and was invariably associated with hydrocephalus and, in 4 reported cases, with an empty sella. These associated findings led to speculations about...

Neurofibromas of the vagus nerve on the neck are very rare. They are asymptomatic, slowly growing. We have seen only one case of neurofibroma of the vagus nerve in the mentioned location during last 22 years. 33-year-old patient with negative family history. She has observed increasing swelling on the right side of the neck for about 2 years. She c...

Craniocerebral trauma is one of major risk factors for development of meningitis. We reviewed 30 cases of bacterial meningitis occurring in community after craniocerebral trauma. Alcohol abuse was significant risk factor occurring in trauma patients with meningitis present in 50% in our cohort (p=0.0001). The most common pathogen in posttraumatic m...

Meningitis associated with bacteremia is rare. Bacteremic form of meningitis occurred in 28 of 201 cases of community acquired meningitis (14%) in Slovakia within last 17 years. Bacteremic meningitis was associated with diabetes (21.4% vs. 7.5%, p=0.02) and with higher treatment failures (32.1% vs. 9.5%, p=0.01) and higher mortality (25% vs. 12.4%,...

Community acquired bacterial (CBM) meningitis in diabetic patients was analyzed for risk factors and outcome in a cohort of 201 cases of meningitis within last 17 years: 15 patients with diabetes mellitus and meningitis were identified and compared for etiology and mortality as well as for neurologic sequellae with all CBM cases.

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk fa...

Glial fibrillary acidic protein (GFAP) is an intermediate filament protein considered to be the best astroglial marker. However, the predominant cell population in adult human brain tissue cultures does not express GFAP; these cells have been termed “glia-like” cells. The basic question about histological origin of adult human brain cultures remain...

Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermedia...

Unlabelled: The aim of this study is presentation of 3 cases reconstructive surgery of the skull base after craniocerebral injury. Injuries and methods: Extensive injuries of the skull base result in communication with paranasal cavities. Diagnostics: The most serious part of the operation is the isolation of the liquor space from the external...

Background: The degree of adherence of craniopharyngiomas to surrounding structures can not be fully assessed by means of preoperative neuroradiological examination. Reasonable extent of the radicality of tumor removal may be established only after its sufficient exposure during the operation. Aim and Methods: The results of morphological studies...

To disclose the relationships of primarily supradiaphragmatic craniopharyngiomas with the third ventricular floor (3rdVF) by means of preoperative magnetic resonance imaging (MRI) and thus to select the surgical approach avoiding the hypothalamic structures. MRI findings in 76 consecutive patients with craniopharyngiomas operated on between June 19...

Multiple meningiomas were diagnosed in a 43-year-old man previously treated with high-dose craniospinal radiotherapy at the age of 7 years for medulloblastoma. We suggest that surveillance MRI after high-dose craniospinal radiotherapy should be extended to several (3-5) decades.

Many cell lines have been established from lung cancer but carcinoma cell lines derived from brain metastases occur rarely. The carcinoma cells growth relatively slowly in comparison with brain cells which often overgrow the tumor cells in early passages. The origin of these rapidly dividing brain cells in carcinoma cultures is discussed with respe...

In this retrospective study, we present the results of 40 surgeries of 40 patients that within the period of 15 years, i.e. from 1985 to 1999 were provided the treatment of 40 lesions of n. fibularis, historically treated as problematic in terms of successful healing. The work provides the fundamental lines of their surgery treatment. From the tota...

This paper presents the results achieved in microtechnique surgeries performed during a 15-year-long period (1985-1999). By performing surgeries on 60 patients, 63 nerves were treated. In 42 patients with injuries of peripheral nerves of upper extremities, 45 nerves were reconstructed by autografts. 14 patients were subjected to reconstructive surg...

Background: The paper presents the results of 42 operations in 42 patients treated for lower extremity nerve lesions during a 15 year period (from 1985 to 1999) at the Neurosurgery Department of Comenius University Medical Faculty in Bratislava. Patients and methods: Forty-five nerves in 42 patients with lower extremity peripheral nerve lesions wer...

Primary or secondary petrous apex cholesteatoma requires surgical management. We describe here live patients with cholesteatoma in the petrous apex on whom different surgical approaches to this region were used. Translabyrinthine transcochlear (transotic) approach with VII-XII anastomosis was used in four patients. In one patient middle fossa appro...

Glial fibrillary acidic protein (GFAP), vimentin (Vi) and cytokeratin (CK) intermediate filament (IF) proteins were studied in glioblastoma cell line GL-15. The immunofluorescence staining revealed strong positive staining for vimentin in all cultured cells. Approximately 20% of analyzed cells showed strong and 50% moderate intensity of staining fo...

The authors present their experience with microsurgical replacement of brainstem lesions within the period 1989-1999. They operated on 35 patients with tumors and with KM? at age ranging from 2 to 65 years. The children suffered prevailingly from gliomas. KM was more frequent in adults. Ten adults were treated for tumors (4 gliomas, 3 haemangioblas...

Clivus meningeoma is a relatively rare tumor with difficult surgical accession. Large and giant tumors acquire a very close relation to the brain stem, cranial nerves and brain vessels. In 10 our of 13 patients, the large tumor diameter exceeded 4 cm, and in half of them it was larger than 5 cm (max. 6.5 cm). Small and medium-sized tumors were remo...

The most frequent cause of syringomyelia is obstruction of the subarachnoidal space in the area of the craniocervical transition or at a spinal level. Between different pathological processes predominate changes the complex of which forms the Chiari malformation (ChM) grade I, Of 23 adults operated on account of ChM 15 suffered also from syringomye...

Etiopathogenesis of syringomyelia, mechanism of its onset and further progress is described differently by nunerous theories. Based on the latest knowledge the obstruction of subarachnoidal spaces on craniocervical part or spinal level is considered the most important underlying cause. Consequently, surgical treatment should aim at full restoration...

Presence of venous angioma (VA) in a close vicinity of cavernous angioma (CA) of the brain enhances the risk of bleeding from CA. However, VA drains the venous blood from surrounding brain tissue and should be left in place during surgical removal of CA. Coincidence of CA and VA was found in 6 of 44 patients operated on for 45 CA during a six years...

Keratin intermediate filaments (Ifs) are specific for epithelial cell differentiation. This study demonstrates the presence of keratin in two recently established human glioblastoma cell lines 8-MG-BA and 42-MG-BA. Immunofluorescence staining was performed on cells within passage 230 to 235 using monoclonal pan-cytokeratin antibodies. The cells wer...

The establishment and characterization of two permanent glioma cell lines (8-MG-BA and 42-MG-BA) are described. Both cell lines were derived from the human glioblastoma multiforme. Analyzed cells were within the passage 200 to 220. The cells in both cultures showed similar morphology. In majority they consisted from flat polygonal cells. Growth kin...

1. The high-resolution 1H NMR (MRS) spectra of human brain tumor homogenates revealed a broad resonance at 5.3–5.4 ppm in glioblastoma multiforme (N = 16) and brain metastases (N = 2). The broad resonance was identified as ceramide, a sphingosine–fatty acid combination portion of ganglioside, indicating an elevated abundance of monounsaturated fatt...

The authors detected in a 30-year-old patient a very rare type of hyperthyroidism caused by a thyrotropin secreting pituitary adenoma. Scintigraphic examination of the pituitary by means of 111In radiolabelled octreotide revealed an increased accumulation of the radiopharmaceutical preparation in the tumour, which confirmed the high density of soma...

Immature or mixed mature/immature teratomas of the pineal region were removed radically in three children. After a period of 26 and 25 months, two patients with immature teratomas are alive and well, whereas in the third patient a mixed teratoma locally recurred and caused a fatal rise of intracranial pressure 11 months after the operation. Regular...

Between 1989 and 1992 we operated 52 patients primarily due to pituitary adenoma. The tumor growths were evaluated microsurgically or histologically as invasive in 29 of them. Radical adenomectomy was achieved in 65.5% of patients with invasive and in 91.3% of patients with noninvasive pituitary adenoma--in 40 cases altogether. Although it was poss...

The authors investigated the possibility of radical removal of adenomas of the pituitary (AH), while preserving remnants of pituitary tissue, in 23 patients with primarily operated hyperfunctional AH producing PRL (14 patients), STH (8 patients) and ACTH (1 patient). Normalization of the pathologically elevated hormone level was achieved by the tra...

In the course of twenty years 92 patients with intracranial epidural haematomas (EH) were operated. In five these patients, i.e. 5.4%, the EH was in the posterior cranial fossa (EHPF). Focal symptoms of compression of the cerebellum and the lower cranial nerves developed only in subacute EHPF. In acute EHPF it was masked by manifestations of an aff...

The mechanical compression of optic nerves, of the chiasma of optic pathways by vessels of Willis circle was revealed in 12 of 34 necropsies of extensive craniopharyngiomas and pituitary adenomas and in three of 109 patients operated on account of these tumours. The localization of pressure changes, from shallow grooves on the surface of optic stru...

The relationship of craniopharyngiomas to surrounding structures was studied by stereoscopic and light microscopy in 30 autopsies. The localization of 4 of the tumors was intra- and suprasellar, 26 lesions were primarily suprasellar. Suprasellar craniopharyngiomas were divided into three groups according to their relationship to the floor of the th...

The anatomical structures of the parasellar region are described from the microsurgical point of view. The study was performed on 20 autopsied specimens.