Biomedical subjects

M Sercl

Publications and source records attributed to M Sercl.

At least 19 recordsLinked to original sources

PubMed2000

[Evaluation of the results of surgery of intracranial supratentorial tumors in 363 children over the past 50 years (1948-1997)].

At the Department of Neurosurgery, Hradec Králové, in the course of 50 years (1948-1997) 363 children, 199 boys and 164 girls (1.2:1) aged under 18 years were operated on for intracranial supratentorial tumours. The average age in children at the time of first operation was 9.3 years; most frequently they participated those of 8 and 11 to 14 years of age. Children aged 1, 2 and 3 years constituted 4.7%, 4.4% and 5% of operations. The tumours were located in: cerebral hemispheres 123 (33.8%), lateral ventricles 17 (4.7%), IIIrd ventricle 5 (1.4%), hypothalamus 26 (7.2%), thalamus 19 (5.2%), basal ganglia 24 (6.6%), sellar region 86 (23.7%), chiasmatic region 38 (10.5%) and pineal region 19 (5.2%). 223 of tumours (61.4%) were located in the midline and 140 of them (38.6%) laterally (in hemispheres and lateral ventricles of the brain). 268 of tumours were histologically verified (73.8%) and 95 of cases were evaluated according to the neurosurgeon's point of view and/or to the clinical and CT controls (26.2%), because of the biopsy (especially in the pre-CT era) was highly riskfull. Histological typing of tumours was retrospectively reevaluated according to the present WHO classification. Summarized 53 types of tumours were differentiated. The most frequent lesions were various variants of astrocytic gliomas (135 = 37.2%). Further on the craniopharyngiomas dominated (73 = 20.1%). The tumours were operated on through craniotomies 299 times, by primarily drainage operations 52 times, functions 6 times, stereotactically 8 times and or by combination of these operations 82 times. Reoperation was needed for postoperative complications in 1.7% (6 times) and for delayed recurrence in 11.3% (41 times). The postoperative mortality (up to 1 month after initial surgery) was in 156 children operated on in pre-CT era (between 1948 and 1977), as compared with 207 children operated on in the era of CT (between 1978 and 1997) in astrocytomas 3.8:0%, pilocytic astrocytomas 6.5:2.8%, craniopharyngiomas 15.4:0% and in all tumours 12.2:2.9%. 16 children with orbital tumours (the average age 5.8 years) operated on with orbitofrontal approach were also evaluated. 14 of them survive for 5-37 years (on the average 16.6 years). The chronological development of diagnostic and operative processes of supratentorial tumours in children's care is discussed. The prognostic elements of present histobiological classification of tumours are positively evaluated.

Adolescent↗

PubMed1998

Posterior cranial fossa surgery in 454 children. Comparison of results obtained in pre-CT and CT era and after various types of management of dura mater.

At the Department of Neurosurgery, Hradec Kralové, 454 children (aged under 18 years) were operated on for posterior cranial fossa lesions in a period of 49 years (1948-1996). The majority (402) had tumours: cerebellar astrocytomas 149 (37.1%), medulloblastomas 139 (34.6%), brain stem gliomas 46 (11.4%), ependymomas 28 (7.0%), and others 40 (9.9%). Postoperative mortality was compared for the pre-CT era (1948-1977) and the CT era (1978-1996): astrocytomas (8.6%:4.7%), medulloblastomas (14.9%:2.9%), brain stem gliomas (21.7%:19.0%), ependymomas (18.2%:6.3%), and others (40.0%:7.4%). The initially high mortality was due to insufficient intracranial decompression, brain oedema and disturbances of cerebrospinal fluid circulation. Obstructive hydrocephalus was treated in 53 children with tumours and 25 with aqueduct stenoses, by Torkildsen's drainage in 5.5%, and/or by catheterisation of aqueduct in 12.3%. The main postoperative complications of medial posterior fossa surgery in 429 children operated on were: pseudomeningocele (12.3%), active hydrocephalus (6.2%) and CSF leakage (4.6%). Only 8.2% had shunts placed for these complications. We presume that this low percentage of shunts used results from a frequent use of duraplasties and drains installed at the primary operation. The dura mater was initially (1948-1954) left open (50 cases), and later (1955-1958) also sutured (37 cases), and from 1958, onward, and especially from 1961, reconstructed by a medial approach by means of various grafts (377 cases). In all, duraplasty was performed in 81.6% of cases. The grafts used for dura mater reconstruction were prepared from autogeneic (1.6%), allogeneic (72.3%), xenogeneic (24.8%), or synthetic (1.3%) material. They were successful in 99.2% of cases (all materials). Our own suture technique for posterior fossa duraplasty is presented.

Adolescent↗

PubMed1998

Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child.

A cyst of the choroid plexus of the left lateral ventricle with intermittent blockage of the foramen of Monro and initially with invagination of the III ventricle in a child is described. In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ballvalve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. Choroid plexus cysts localised in the anterior part of lateral ventricles are very rare, and all reported cases have been in male patients. According to the literature our case is only the third ever described in a child.

Brain Diseases↗

PubMed1997

Detailed evaluation of 2959 allogeneic and xenogeneic dense connective tissue grafts (fascia lata, pericardium, and dura mater) used in the course of 20 years for duraplasty in neurosurgery.

Surgical experience with 2959 allogeneic and xenogeneic dense connective tissue grafts (1767 of fascia lata, 909 of pericardium, and 283 of dura mater), used in 2665 neurosurgical operations performed in the course of 20 years (1976 to 1995) is reported. Duraplasty using either allogeneic or xenogeneic grafts has had a similar, and favourable clinical outcome. Nevertheless, the pliable deep frozen fascia lata grafts, which could be used in any location, have been reserved for sella turcica plugging, anterior cranial base plasty, aneurysmal wrapping, and surgery of lipomyelomeningocele. Pericardium and dura mater grafts were in the majority of cases used over the brain convexity and posterior cranial fossa. Ovine pericardium proved to be superior to bovine and allogeneic pericardia because of its workability, flexibility, reduced thickness, and better transparency. Postsurgical complications occurred in 7.3%, and they were: 1) cerebrospinal fluid fistulas in 2.8%; 2) meningites in 2.3% (aseptic 1.4%, bacterial 0.8%, and tumoural 0.1% meningites); 3) pseudomeningoceles in 2.2%; 4) wound infections in 0.6%; 5) malresorptive hydrocephalus in 0.5%; and 6) adhesions to nerve tissue in 0.5%. The majority of complications healed without surgery. Forty-eight grafts (1.6%) failed to fulfil the requirements of the surgeon, and 46 of them were re-operated upon. Though another thirty-nine grafts healed successfully, 39 shunts (1.5%) had to be performed for malresorptive hydrocephalus (0.9%), and/or for a big pseudomeningocele (0.6%). So, the pure complication rate in 2665 duraplasties was 3.1%. The complex evaluation of the allogeneic and xenogeneic grafts (fascia, pericardium, and dura mater), used for duraplasty in neurosurgery during the last 20 years proved them, as remarkably good, with a success rates of 96.9%.

Adult↗

PubMed1996

Allogeneic cartilage used for skull base plasty in children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea.

Three children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea were operated on at the Department of Neurosurgery, Hradec Králové. In two children, aged 4 and 9.5 years, freeze-dried allogeneic costal cartilage was glued into the skull base defect. This plugging was covered up with deep frozen allogeneic fascia lata. In the third child, an only 1-year-old boy, after transection of the neck of the encephalomeningocele freeze-dried allogeneic dura mater was glued on extradurally and deep-frozen allogeneic fascia lata applied intradurally. The cerebrospinal fluid rhinorrhea ceased immediately after surgery. Spontaneous atrophy of the intranasal portion of the encephalomeningocele was demonstrated respectively 11, 1, and 7 years postoperatively on computed tomography. To evaluate cartilage healing histologically, the extracted allogeneic cartilage used for orbital roof plasty after 4 months was examined. The extent of spotty regressions represented about 7% of the tissue volume. It is stressed that, once diagnosed, intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea should be operated on for prevention of meningitis as soon as possible.

Brain↗

PubMed1995

Impedance monitoring in the stereotactic localization of intracranial structures.

Measurement of tissue impedance is a simple objective method for the localization of intracranial structures. Continuous bipolar impedance monitoring was performed during various CT-guided stereotactic procedures in 36 patients with brain pathology. The obtained values of the impedance profile along the trajectory were compared with the tissue density on CT scans or angled coronal and sagital CT reconstructions intraoperatively. The main goal was the selection of optimal biopsy targets and safe probe trajectory. Histologic findings of serial transtumoral biopsy were retrospectively correlated with both CT (or MRI) transposed data and patterns of tissue impedance. Intraoperative impedance monitoring enhanced the accuracy and safety of CT-guided procedures. The histologic examination of representative tissue samples avoids the risks of "blind" surgical or radiation management. This technique is reported with 6 illustrative cases.

Adult↗

PubMed1995

Epilepsy associated with low-grade brain glial neoplasms.

In 1991-1993, 52 patients underwent surgery for low-grade supratentorial glioma. In 37 of them (astrocytoma 22, oligodentrocytoma 12, oligodendroglioma 2) seizures, often refractory to drug therapy, appeared as the first symptom. These cases were retrospectively analyzed. The patients had partial seizures: simple, complex, or secondarily generalized (preoperative duration: from 3 days to 17 years (mean 2 years); frequency: between 1 and 2/year and over 10/day). Neurological examination either revealed slight focal changes or was normal. Conventional craniotomy and resection of a tumor, without intraoperative electrocorticography, was performed. Partial resection was performed in 73%, subtotal in 5%, "total" in 22% of the cases. Postoperatively, 27 patients had focal radiotherapy, 3 of them in combination with chemotherapy. Two patients were reoperated. Out of 33 alive (89%), about two-thirds appear normal by neurological examination and are seizure-free at present (mean follow-up period 28 months). Most remain on antiepileptic drugs at lower doses. Histological and immunohistochemical analyses of resected tissue together suggest that the peripheral zone of cortical tumor infiltration may participate on epileptogenesis.

Adolescent↗

PubMed1994

Posterior fossa duraplasty in children: remarks on surgery and clinical and CT follow-up.

A series of 314 posterior fossa duraplasties in children were performed at the Department of Neurosurgery, Hradec Králové, over the past 33 years. Computed tomographic (CT) imaging was used to compare the healing of various kinds of collagenic dural substitutes--allogeneic fascia lata, allogeneic dura mater and xenogeneic pericardium. Early (8 days to 3 months following surgery) and late (1-18 years following surgery) axial CT scans with sagittal reconstruction for duraplasty in 55 children were evaluated. In early postoperative CT scans, epidural collections of cerebrospinal fluid, sanguinolent liquid or haematoma and/or pseudocysts or pseudomeningoceles appeared. In late CT follow-up, calcifications and ossifications in the "suboccipital coverings complex" (SCC) gradually developed and pseudocysts or pseudomeningoceles rarely persisted. It is concluded, on the basis of perioperative, clinical, and CT examinations, that posterior fossa duraplasties in children formed an important anatomical barrier and regardless of the type of graft had a favourable outcome; CT was shown to be a suitable method for the demonstration of dural grafts at the site of craniectomies.

Adolescent↗

PubMed1994

Catheterobronchial fistula due to vena cava superior thrombosis as a late complication of ventriculoatrial shunt.

A case of a catheterobronchial fistula as a rare late complication of a ventriculoatrial shunt is reported. The ventriculoatrial shunt was implanted in a 4-month-old boy suffering from extreme postinfectious hydrocephalus. During the following years, twelfth nerve palsy on the right, vertebralgias, and salty taste sensations in the mouth associated with intermittent coughing and swelling of the neck and supraclavicular region on the right side developed. Valvography established a diagnosis of fistula 12 years after the implantation of a shunt. Ultrasonography of the neck and mediastinum and contrast-enhanced dynamic computed tomographic scanning demonstrated a catheterobronchial fistula to the subsegmental bronchus of the anterior segment of the right upper lung lobe, a thrombosis of the right internal jugular and both right and left brachiocephalic veins and the superior vena cava, and an extensive collateral venous system mainly draining into the azygos vein. Normalization of cerebrospinal fluid and blood flow and pressure allowed extraction of the "atrial" catheter without complications. One year after surgery the boys is in good health and without signs of shunt dependence.

Brain↗

PubMed1992

[Computer tomography of the brain in children. II].

The second part of the study "Computerized tomography of the brain in children" is a continuation of the first one published in Supplement for the Collection of Scientific Works by Charles University's Medical Faculty in Hradec Králové from 1990. The former is issued from analyzing 1283 pathological CT findings investigated in newborns and children up to 15 years of age. The present study is concerned with not only the precise diagnosis of the lesion site but also with the type diagnosis and observation of further development of either affected or operated on children brain. When investigating ventriculomegalies, altogether with critical approach to the CT possibilities in diagnosing various types of hydrocephaluses and atrophies, which have been the most frequent pathological findings in this set, the authors also proceeded by monitoring reparative capacities of the brain tissue or post-surgery drainage complications. The problems of children CT investigation are similar to those in adults as far as the brain abscesses, empyemas and non-bacterial encephalities are concerned. A possibility of repeated examinations is of importance in selecting therapeutical approaches and observing their effect. A considerable amount of viral inflammations and the toxoplasmosis appear to be specific for children's age with yet intrauterine course of several of them. They result in severs cerebral damage, hydrocephalus and atrophy with frequent both periventricular and parenchyma calcifications. The acute meningitis did not show unambiguously positive CT findings, though they are frequent to result in mainly the obstructive or hyporesorptive types of hydrocephalus as well as atrophic changes. Only the 8 per cent of post-inflammatory intracranial patients showed normal time-delayed CT finding. From neurocutaneous syndromes, those most frequently occurring were cerebral manifestations of tuberous sclerosis. Apart from periventricular calcifications within the hamartomatous node, the three patients showed large pseudotumorous formations responsible of the deformity of lateral ventricles. In the frame of neurofibromatosis, the authors diagnosed the stenosis of aqueducts, conditioned with adjacent gliosis, and the dysplasia of the base of medial cranial fossa which caused the temporal lobe to prolapse into the fossa subtemporalis and the orbit. The exceptional finding in this set of patients was that of angioreticuloma within the ponto-cerebellar angle in a 10 year-old boy. According to literature, this type of hamartoma does not occur in children of prepubertal age. In 37 children of our set, the extra- or intraparenchymal cavities were diagnosed. Those most frequently occurring were arachnoidal cysts at the pole of temporal lobe as well as porencephalic intraparenchymal cysts.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1991

Benign cyst of the paramedian pontine tegmentum.

A benign ovoid cyst, without an epithelial lining, localized in the paramedian pontine tegmentum, was examined by computed tomography (CT) and magnetic resonance imaging (MRI) (25 x 15 x 15 mm) and successfully operated upon. The one-and-a-half syndrome (horizontal gaze palsy to the right and paralysis of adduction of the right eye) and ipsilateral "peripheral" VII nerve palsy dominated the clinical picture. Fenestration, 5 mm in diameter, of the cyst wall through the floor of the IV ventricle was performed and 2.6 ml of clear, colorless fluid was evacuated. Inspection of the cyst, using the operating microscope, revealed a smooth, white, glistening cavity with no evidence of other pathological tissue. Duraplasty was performed with allogenic pericardium. Neurological symptoms improved immediately after surgery. Light and electron microscopy of the cyst wall revealed a fibrillar astroglial network and fragments of ependyma at the ventricular side of the biopsy.

Adolescent↗

PubMed1990

[External lumbar cerebrospinal fluid drainage with controlled flow-- its use in pediatric neurosurgery].

The authors describe cases of external lumbar CSF drainage with a regulated flow inserted lumbally or in the pseudomeningocele in children. During flow regulation during operation they were guided by the finding in the surgical field, during therapeutic use (in the course of 1-8 days) by setting the CSF output at 15 ml/hour. Drainage was used in extradural approach to the orbit, for treatment of liquorrhoea in surgical wounds of the posterior fossa, frontal and temporal drainage to clear the CSF in meningitis and to make inner drainage possible. CSF fistulae healed even after major craniectomies and infections due to the resistance of allogenic and xenogenic dural transplants. For external CSF drainage the authors used lumbar needles, intravenous Portex kits or original Cordis kits. The latter proved to be the best.

Central Nervous System↗

PubMed1990

[Computer tomography of the brain in children. I. 1. Perinatal encephalopathy of vascular origin. 2. Congenital brain malformations].

CT findings are evaluated in 103 children with vascular lesions (aged up to 15 years), and in 59 children with congenital cerebral and cerebellar malformations. Their maximum has been stated to occur perinatally due to hypoxic and ischemic brain affections. Therefore most of diagnostical problems were related to the differentiation of hypodense immature brain from ischemic changes. Mentioned findings were always correlated with clinical course. Similar confrontations along with earlier CT control examination may be helpful in distinguishing milder transitory postischemic oedema from serious necrotic and malatic changes. In more aged children, vascular lesions are of rare occurrence being different in etiology. More unambiguous CT patterns are obtained in vascular changes with hemorrhagies. Of special importance in their onset is a hypoxic attack with subsequent venous bleeding mainly into the germinative matrix. While well tolerated in premature newborns, the extensive hemorrhagies in on-term ones have worser prognosis, resulting in significant changes on control examination, predominantly hydrocephalus and porencephalia. Atrophies of various extent were the most common consequence of all encephalopathies of vascular origine. In almost a half of congenital brain and cerebellar anomalies, unsignificant findings of smaller middle line cavities were obtained predominantly in pellucide septum. From the serious findings, most frequent were different varieties of dysgenesis, hypogenesis up to agenesis of corpus callosum combined sometimes with either the lipomas or cysts. Another findings consisted in Dandy-Walker's cerebellar malformation, holoprosencephalia and only two patients manifested hydrencephalia and basal meningoencephalocele. Most of diagnostical effort has been made in mainly anomalies associated with ventriculomegalia and/or cystic formations in order to elucidate the eventual communication between the structures mentioned. In addition, CT ventriculo-cysto-orcisternography has also been performed using smaller amount of nonionic contrast. At present, an important portion of CT examinations may be replaced with sonography which is more simple as used in both newborns and toddlers.

Adolescent↗

PubMed1989

[Repair of the dura mater in children using xenogenic pericardium].

The authors report their five-year experience with the use of xenogenic calf pericardium for plastic operations of the cerebral and spinal dura mater which they introduced into neurosurgical practice in 1983. Of 165 grafts they selected 50 which they used in children for the plastic operation of the dura mater above the posterior cranial fossa, above the convexity of the brain and at the skull base. The xenogenic pericardium proved successful and resolved also the shortage of allogenic collagenous tissues (fascia lata, dura mater) used for plastic operations of the dura mater. Moreover, due to its resistance it achieved priority in some indications and localizations. When used, certain conditions must be met to ensure satisfactory incorporation (suitable size, intradural submersion, careful suture).

Bioprosthesis↗

PubMed1989

Congenital dermoid cysts over the anterior fontanel. Report on 13 cases in Czechoslovak children.

The authors report on 13 cases of dermoid cysts over the anterior fontanelle in Czechoslovak children. These children were 2-19 months of age; with a male-to-female ratio of 2:1. The cyst sizes ranged from 10 to 30 mm. Hence, the number of cases published in the world so far in children has increased to 174. Simultaneously, the number of European cases has increased to 30 (17.2%). Nevertheless, the dominance of the reported cases is still 74 in America (42.5%) and 45 in Africa (25.9%).

Dermoid Cyst↗

PubMed1989

Bobble-head doll syndrome associated with the III ventricular cyst. Three cases in children 7 years after CVP or CVA shunting.

Thirty-nine cases of the bobble-head doll syndrome have been operated upon and are described in the literature. The authors re-evaluate three cases of III ventricle cysts treated with cystoventriculoperitoneal (CVP) or cystoventriculoatrial (CVA) shunting 7 years ago. In the first case (a 4.5-year-old girl), the CVP shunt was removed after 16 months due to suppuration around the device after trauma of the scalp. Nevertheless, the communication between the ventricle and cyst continued and the bobbing never returned. In the second case (a 10-year-old girl), after 4.5 years a pseudocyst at the end of the peritoneal catheter was accidentally found. It was evacuated and, as in the third case (a 17-year-old boy) follow-up for 7 years showed excellent results from the clinical point of view and CT scans.

Adolescent↗

PubMed1989

Xenogeneic pericardium as a dural substitute in reconstruction of suboccipital dura mater in children.

A 5-year experience with the glutaraldehyde-stabilized freeze-dried radiation-sterilized calf pericardium used as a dural substitute is reported. The structure of pericardium xenograft is compared with other collagenous materials used for duraplasty (allogeneic fascia lata and dura mater) by light and electron microscopy. The special neurosurgical techniques involved in using pericardium xenografts in the reconstruction of suboccipital dura mater in children are presented in detail.

Animals↗

PubMed1989

[Developmental cysts in the area of the quadrigeminal plate in children].

The authors describe three cases of operated developmental cysts in the area of the laminae quadrigeminae in children. The performed multiple fenestrations or excision of the wall of the cyst and effective communication with the subarachnoid or ventricular system, as well as a plastic operation of the dura mater with collagen tissue from a Tissue bank. By means of light microscopy the walls of two cysts were examined (one arachnoid and one glioependymal), one cyst was examined by electron microscopy (glioependymal). The authors supplemented by their own cases the number of hitherto described cysts in the collicular region to 56.

Arachnoid↗