Biomedical subjects
Publications and source records attributed to P Kolasa.
We present a case of rare orbital roof haemangioma infiltrating the medial and lateral walls of the orbit, zygomatic bone and lesser and greater wings of the sphenoid. The tumour was totally excised by the frontolateral approach, followed by craniofacial and orbital roof reconstruction.
Basing on own material 25 patients with symptoms of intracranial structures pressed by aneurysm sack have been presented. The patients were treated with endovascular method in MDS system at the Department of Neurosurgery, Copernicus Hospital in Łódź. The aneurysms were diagnosed basing on neurological symptoms--cranial nerves damage, focal brain lesion and headaches. The aneurysms surgically difficult and were qualified for endovascular treatment. Ninety two per cent of aneurysms were big or giant; 92% with a wide neck. Total or almost total aneurysm closure was obtained in 59% of cases. The patients were observed 6 to 71 months. Follow up of 11 patients (50% observed group) revealed complete recovery in 8, neurological improvement in 3 cases.
Endovascular treatment of cerebral arteriovenous malformation (AVM) lies in selective catheterisation through feeder and AVM nidus. Sticking mixture is applied after proper verification of microcatheter location. Malformation embolisation is normal when the vessel net is of small diameter. In the presented case embolisation material penetrated cerebral vein system and then lungs, where numerous emboli developed. X-ray where confirmed pulmonary embolism resulted in severe respiratory insufficiency. Treatment of this rare complication as well as the cause of its occurrence have been presented. Prevention of such complications has been considered.
Horner's syndrome is most frequently observed in the course of inflammatory, neoplastic and traumatic processes in the area of medulla oblongata, Gasserian ganglion and the lower part of brachial plexus. Horner's syndrome resulting from internal carotid artery aneurysm haemorrhage is very rare. A case of rapid appearance of Horner's syndrome initially treated as contrlateral exopthalmos has been presented. After several weeks headaches and neck pain accompanied Horner's syndrome on the same side. The CT-scan and cerebral angiography were normal. Repeated cerebral angiography with carotid arteries exhibition revealed an aneurysm on the extracranial part of the internal carotid artery. The aneurysm location was considered to be surgically difficult and thus endovascular treatment was applied (coiling). The regression of Horner's syndrome was observed 6 months after the treatment.
Pulsating exophthalmus develops most frequently in the course of penetrating or bitemporal head trauma. Idiopathic form is even more rare. Orbit venous system over-loading with pathological arterial blood infiltration is the cause of pulsating exophthalmus. A patient with congenital carotid-cavernous fistula (right eyeball enlargement and noise), suffering from head trauma after road accident has been presented. Carotid-cavernous fistula was diagnosed and than treated casually by endovascular closure of the infiltration between internal carotid artery and cavernous sinus. After 5-month treatment regression of the noise and exophthalmus was observed.
Aneurysms of diameter above 25 mm, determined as giant aneurysms, are thought to be surgically difficult. The most common symptom of the presence of aneurysm is subarachnoidal hemorrhage. Giant aneurysm may cause focal neurological symptoms, very rarely may show symptoms of intracranial hypertension. In the presented case a 47-year old woman after the first epilepsy attack the dominated symptoms were those of intracranial hypertension. CT suggested brain tumour of 70 mm diameter. Brain angiography revealed giant aneurysm of the left middle cerebral artery. After having considered differed method of therapeutic management, microsurgical operative technique was applied in general anesthesia with brain protection.
We report here relatively rare lipomatous metaplastic changes, probably related to a prolonged clinical course, in not otherwise specified transitional meningioma. This lesion appears to have evolved over 30 years, with the initial diagnosis of multiple sclerosis. Histologically, it was composed of clusters and whorls of polygonal and spindle cells characteristic for transitional meningioma, with large areas of cells with lipid cytoplasmic accumulation, closely resembling mature adipocytes. The lipidization of other brain tumors and the histogenesis of these lesions in meningiomas on the background of meningeal embryogenesis are also discussed.
We report a prospective series of consecutive cases of primitive neuroectodermal tumor (PNET) studied by electron microscopy. Virtually all specimens showed a differentiation along neuroblastic lines as evidenced by the presence of neurites, dense-cored vesicles, microtubules and adhesive plaque junctions. We observed also numerous intracytoplasmic cilia and autophagic vacuoles. Synaptic specializations were only rarely seen. We conclude that PNET is a tumor category which is not undifferentiated ("primitive") and clearly exhibits features of neuroblastic differentiation.
We report here ultrastructural and immunohistochemical studies of neuroblastic differentiation in the retrospective (n = 17) and prospective (n = 26) series of primitive neuroectodermal tumors (PNETs). By electron microscopy, neuritelike structures containing parallel-oriented microtubules, adhesive plaque junctions, and pleomorphic dense-core vesicles were found in the majority of tumor specimens while synaptic specializations were very rare. By immunohistochemistry, synaptophysin appeared to be the most reliable marker for neuroblastic differentiation present in the most reliable marker for neuroblastic differentiation present in the majority of tumors, while 200 kDa neurofilament protein was immunovisualized in a lower proportion of tumors. Glial fibrillary acidic protein (GFAP) was expressed in both reactive astrocytes and in a small proportion of otherwise typical neoplastic cells. We conclude that the majority of PNETs revealed diverse differentiation and that electron microscopy is still the most reliable tool for its detection followed by immunohistochemistry for synaptophysin.
Typical "Codubix" prosthesis usually applied to cover cranial defect was used in craniofacial reconstruction. In this case the defect resulted from total removal of cranial basis neoplasm infiltrating orbital roof and surrounding structures. The cranial defect included right frontal bone--superciliary arch, orbital roof and margin; zygomatic bone frontal part junction and the lesser and greater wings of the sphenoid. Cranial reconstruction in this spatially differentiated area is technically difficult. The authors discuss the way of standard prosthesis modification in order to apply it in craniofacial reconstruction. Follow-up radiological and aesthetic results are presented.
Bilateral trigeminal neuralgia is a rarely observed suffering. It is usually localised on one half of the face and few years after therapy or idiopathic regression it appears on the other side. In exceptional cases trigeminal neuralgia appears on both sides at the same time. Neurovascular decompression or neurotomy in the pontocerebellar angle are the most effective therapy. In the last 25 years of 257 surgically treated patients with trigeminal neuralgia bilateral pain was found in 12 cases (5%). Retrospective assessment of the used method, in our department, in the treatment of trigeminal neuralgia demonstrated efficacy of this procedure.