Biomedical subjects
Publications and source records attributed to J Slósarek.
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On the basis of neurological, psychological and computed tomographic studies of the head early consequences of microsurgical elimination of supratentorial brain aneurysms were analysed in a group of 37 patients. It was shown that this method of aneurysm treatment may lead to brain oedema near the operation site. Oedema development was observed most frequently in cases of prolonged pressure exerted by spatulae on the brain tissue during the operation, aneurysm location in the anterior cerebral artery system and in cases operated on from 4 to 10 days after subarachnoid haemorrhage.
Late internal hydrocephalus has been diagnosed in 68 (44%) out of 154 patients treated for the ruptured cerebral aneurysms, and in 37 (31%) out of 120 patients, who underwent cranio-cerebral trauma. To establish the indications for shunts, CT scans of the skull, tomoventriculography, and infusion tests have been carried out in 38 patients. It has been found, that increased transparency of the areas below cerebral ependyma, the lack of cerebral cortex sulci, and imaging of the temporal horns together with internal hydrocephalus in CT scans indicate an active process and are indications to shunting. If there are no signs of active process in CT scans despite of the presence of hydrocephalus, tomoventriculography should be performed to establish more fully the indications to shunting.
The effects of classical and microsurgical methods of exclusion of supratentorial intracranial aneurysms on the development of ischaemic changes at the site of approach to the aneurysm were studied. In cases of internal carotid artery aneurysms and middle cerebral artery aneurysms the use of microscope reduced the occurrence of ischaemic changes at the site of approach. In cases of aneurysms of the anterior cerebral artery system the frequency of these changes was similar with both methods. The size and location of these changes and the degree of psychical changes caused by them were similar with both methods.
An original method of qualification for surgical treatment of patients with non-traumatic intracerebral haematoma is described. The qualification is based on the main elements of the intracranial volume compensation: 1. function of midline structures (F), 2. intracranial pressure features (I), 3. midline structure shift (S). The FIS method was applied in 134 patients; 83 of them were treated surgically and 51 were treated conservatively. The control group comprised 60 patients treated surgically or conservatively with qualification based on other criteria. The use of the FIS method in the preliminary management of patients with non-traumatic intracerebral haematoma made possible a great increase of the survival rate and improvement of the late results of treatment.
A case of the myeloblastoma involving brain and spinal cord in a patient with acute myelomonocytic leukemia is reported. Numerous mitoses within the tumor provide an evidence for local cell proliferation in the neoplasm. Surgery combined with radiotherapy is suggested as the most efficient modality of the treatment.
On the basis of neurological, psychological and computed tomographic examinations of the head late consequences are presented of classical exclusion of middle cerebral artery aneurysm. It was demonstrated that compression of the brain with a spatula and the extent of shifting apart of the walls of the lateral fissure of the brain during the operation may lead to ischaemic changes in the temporal lobe near the lateral fissure. These changes may cause impairment of mental efficiency late after the operation. It was shown also that during the operations for aneurysms of the middle cerebral artery at the site of its division the approach by forcing apart the fissure over the site of division would be less damaging than the approach along the trunk of the artery.
The effect of the classical exclusion of internal carotid aneurysm with access by frontotemporal craniotomy on late therapeutic result and on the development of ischaemic changes in the area of access was analysed. It was shown that with this method of surgical treatment the ischaemic lesion developed most frequently in the temporal lobe pole, and may lead to persistent impairment of mental ability and symptoms of characteropathy later on. It was demonstrated that the occlusion of bridging veins reaching the sphenoparietal sinus and ligation of the neck of the aneurysm increased the risk of ischaemic lesions development at the site of spatula pressure during the operation.
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The effects were analysed of various techniques of classical exclusion of aneurysms in the anterior cerebral artery system on the late therapeutic result and on the development of ischaemic lesions in the area of approach to the aneurysm. The approaches used were: interhemispheric, fronto-temporal and fronto-temporo-sphenoidal, and the aneurysms were excluded with a ligature or metal clip. The best method of approach was chosen after analysis of late results of neurological, psychological and CT studies. It was demonstrated that pressure of a spatula during the operation may produce permanent ischaemic changes at the site of the pressure which may lead to persistence of psychic disturbances late after the operation. It was shown also that the most favourable classic technique of operation in cases of aneurysms in this portion is the fronto-temporo-sphenoidal approach with use of a metal clip.
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On the ground of the clinical status and indicators of intracranial pressure instability and cerebral arterial reactivity the authors evaluated the efficiency of intracranial volume compensatory mechanisms in 21 patients before and after operations for epidural and subdural haematomas and spontaneous intracerebral haematomas. The epidural haematomas in a greater degree but less permanently exhausted the efficiency of the compensatory mechanisms than subdural haematomas and after their removal these mechanisms regained easier their efficiency than after removal of subdural haematomas. In cases of spontaneous intracerebral haematomas the efficiency of the compensatory mechanisms is only slightly decreased.
In 8 patients with progressive open hydrocephalus and in 6 with stabilized hydrocephalus the infusion test was done and the instability index of the intracranial pressure was determined. In cases of progressive hydrocephalus the values of the test and index indicated a considerable reduction of the efficiency of cerebrospinal fluid resorption. In cases of stabilized hydrocephalus the results of the test and index suggested a better efficiency of CSF resorption. The test and index are useful in the differential diagnosis of progressive open hydrocephalus against stabilized open hydrocephalus.
The authors present a case of intaracranial chondrome originating from the pia mater and discuss the development of intracranial chondromas and role of cranial trauma in it.
Continuous measurements of intracranial, pressure were conducted by the extradural method in 40 patients with various types of skull trauma. A correlation was demonstrated between the value of this pressure and the clinical condition of the patient only with high values of the pressure, in which nearly always wave-like pressure changes were observed. The occurrence of wave-like changes was a more reliable sign of threatening cranial hypertension than the value of intracranial pressure. Continuous measurement of pressure during intravenous administration of glycerol demonstrated that a significant fall of pressure preceded the regression of clinical signs of intracranial hypertension.
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An index of intracranial pressure instability is calculated as a new way to evaluate the capacity of intracranial voluminal compensation in patients suffering from cranio-cerebral trauma. The value of the index is determined by mutual relations of intracranial pressure standard deviations measured during 3-minute periods before and after intracranial administration of 2 ml of 0.9% NaCl. Normal physiological range of the index was evaluated in controls without intracranial pathology.