Interleukin 1beta-511 C/T polymorphism and risk of aneurysmal subarachnoid haemorrhage.
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Chromosomes, Human, Pair 2↗
Biomedical subjects
R Czepko
Publications and source records attributed to R Czepko.
Characteristics and surgery of aneurysms of the proximal (A1) segment of the anterior cerebral artery.
AIM: Proximal anterior cerebral artery (A1) aneurysms are considered to be rare or even unique. Proper surgical planning around A1 segment is particularly essential in order to avoid injury of tiny perforating arteries. METHODS: In 17 patients with angiographically or intraoperatively diagnosed A1 aneurysms, representing 0.8% of 2 124 aneurysm patients treated surgically at our institution between 1991 and 2003, clinical presentation, neuroradiological findings, surgical treatment methods and outcome were retrospectively analyzed. RESULTS: Sixteen patients presented with subarachnoid hemorrhage; A1 aneurysms were ruptured in 13 cases. Five patients (29%) had multiple aneurysms. In all cases A1 aneurysms were saccular and their maximum diameter ranged from 4 to 25 mm, average, 7.2 mm; in 4 cases they projected from the origin of the perforating artery, in 6 at the bifurcation of the internal carotid artery, in 5 at the anterior communicating artery and in 2 from the convexity of the parent artery. In 15 patients aneurysms were clipped via ipsilateral pterional approach and in the remaining 2, including a case with a second middle cerebral artery aneurysm, through contralateral approach. Eleven patients had excellent outcome, three good, and three died. CONCLUSIONS: Angiograms must be thoroughly analyzed to correctly assess origin of the aneurysmal neck, and to plan the operative procedure as radiological presentations of distal or proximal A1 lesions resemble those of anterior communicating artery and internal carotid artery bifurcation aneurysms, respectively. Contralateral approach may facilitate surgical elimination of selected A1 aneurysms or enable one-stage clipping in patients with multiple bilateral aneurysms.
Adolescent↗
[Pituitary function after transsphenoidal surgery for pituitary adenoma].
Nowadays transsphenoidal surgery is the method of choice in most cases of pituitary adenoma treatment, both functioning and non-functioning. This method is considered to be safer than transcranial approach, as lower incidence of complications, particularly hypopituitarism, is observed. The aim of the study was to evaluate the pituitary function after transsphenoidal surgery. 20 patients (mean age 49.3 +/- 13.9 years) were included into the study. The anterior pituitary insufficiency was defined as an inadequate excretory response to metopirone, LH-RH and TRH stimulation. Diabetes insipidus was diagnosed based on clinical symptoms. Hypopituitarism was diagnosed after surgery in 7 patients, 3 cases had adrenal and gonadal insufficiency, 1 patient had insufficiency of the pituitary-thyroid and gonadal axis and 3 subjects panhypopituitarism. Diabetes insipidus was still present in 2 patients, 3 months after surgery. We conclude that transsphenoidal approach in pituitary adenoma surgery is connected with low risk of iatrogenic hypopituitarism.
Adenoma↗
[Intradural clivus chordoma: surgical treatment with no tumor regrowth 12 years after surgery].
We present a case of a 19-year-old woman treated in the Neurosurgery Department of Collegium Medicum of the Jagiellonian University in Kraków because of the clival chordoma. The patient with one year anamnesis, treated surgically and then rehabilitated, was examined 12 years after she left our department. Radiologically we did not find tumor regrowth. We only found diplopia, but this sign was present from the time of the operation. Such a long time of katamnesis proves possibility of total removal in this type of tumors.
Adult↗
[Risk factors for surgical treatment of supratentorial cerebral arterio-venous angiomas].
The authors present the influence of the selected risk factors in surgical treatment of supratentorial cerebral arterio-venous angiomas. The material represents 38 patients treated in the Neurosurgical Department Collegium Medicum of the Jagiellonian University in the last decade. In 28 of the patients the first sign of angioma was subarachnoid haemorrhage (SAH) and the remaining 10 were revealed with seizures. The assessment of the patients when admitted to the Department was graded using the WFNS scale. The diagnosis was established based on clinical symptoms, the results of computerized tomography and cerebral angiography. The extent of the SAH was graded by the Fisher's scale. The detected angiomas were classified according to the Spetzler scale. All patients were operated on using the microsurgical technique. After occluding the feeding arteries, a selective excision was made into the angiomas and the pathological cerebral tissue. The radical of the operation was controlled by cerebral angiography. The results of the surgical treatment were graded by the modified "outcome" Spetzler scale. The following risk factors were analysed: age, WFNS grade, Fisher's grade and Spetzler's grade. The statistical calculations were made using the chi square test and the Mann-Whitney U-test (p < 0.05). In 7 of the patients the results were very good (18.4%), in 12 the results were good (31.6%), and in 14 the results were bad (36.8%). Five of the patients died (13.2%). There was no statistically significant relationship between the risk factors and the results of treatment of supratentorial cerebral arterio-venous angiomas. In the percentage analysis, the best results were obtained from young patients without SAH and with superficial pattern of venous drainage.
Adolescent↗
[Chordomas. Analysis of 24 cases].
Chordoma is a relatively rare neoplasm originating from the remnants of the embryonic notochord. We analysed 24 cases of chordoma. The patients were divided into groups depending on the localisation. We analysed the results of different methods of therapy: surgical treatment, radiation therapy and combined surgical and radiological treatment. The results were compared with the data from the references.
Adolescent↗
[The influence of shunt surgery on the improvement of cognitive disorders in hydrocephalic patients].
We present 43 cases with cognitive disorders due to communicating hydrocephalus assessed by means of neuropshychological tests before and 4-8 months after shunt treatment. The patients were the part of the 95 hydrocephalic cases (45.3%) operated on in the period of 1993-98 at the Department of Neurosurgery in Kraków. Cognitive functions improvement was detected in 81.4% cases, no changes in 7%, and deterioration in 11.6%. Most often the improvement of lingual function, short memory and attention was noted. The worst prognosis for the prediction of improvement of the cognitive functions had the patients with significant cerebral atrophy, and those with symptoms lasting over 1 years.
Adult↗
[The clinical value of B waves in the cerebrospinal fluid pressure curve during the lumbar infusion test of patients with hydrocephalus].
There are still many problems in the selection of hydrocephalic patients for the shunt treatment. Many investigations focus to find out a new and reliable prognostic factors including the parameters of lumbar infusion test (LIT). The aim of this study is to evaluate the B waves observed during the LIT, and to assess the prognostic value of the B waves in hydrocephalic patients. 153 patients with communicating hydrocephalus (ventricular index > or = 0.8) were assessed by means of the LIT. B waves were detected in 70 patients (45.8%). Primary assessment was verified by the Fourier analysis. The relationship was analysed between B waves and the resistance to outflow (R), new steady state pressure (Pns) and the standard deviation of the Pns (SDPns). The results of treatment depending on the presence of B waves were assessed in 95 shunted patients (two categories: improved/not improved). Statistical analysis was performed using Statistically 5.1 for Windows. Chi square test, Mann Whitney U-test, and the Student T test were applied (p < 0.05). There was statistically significant relationship between B waves and the increasing values of R (p = 0.0002), Pns (p = 0.0002) and SDPns (p = 0.0000). Positive prognostic value of the B waves was found in the group of 95 shunted patients (p = 0.0152). 1. B waves during LIT appear significantly more often in patients with increasing compensation impairment. 2. B waves detected in LIT have a good prognostic value in hydro-cephalic patients.
Adult↗
[Early results of treating pituitary adenomas by means of transcranial and trans-phenoidal approach].
Among the methods of the surgical approach to the pituitary tumours, transsphenoidal (TS) route replaced transcranial (TC) route in the majority of patients. The authors present the development of the surgical treatment of pituitary tumours, and present the early results of treatment by means of both methods of surgery based on the experience of the Department of Neurosurgery in Kraków. Consecutive 45 cases of pituitary adenomas treated by means of TC route (1989-1998)--I group, were compared to 57 cases operated on by means of TS approach (1996-1999)--II group. The other tumours and re-operated patients were excluded from the study. The following factors were compared: the size of treated tumours, the radicality of tumour excision (subtotal, partial), the presence of the massive hypothalamic dysfunction, the presence of diabetes insipidus, changes in visual field, early results of treatment (good, bad, surgical deaths). Using transsphenoidal approach significantly more tumours were removed subtotally (except of large tumours), massive hypothalamic dysfunction was eliminated, surgical deaths were reduced, and the chance for the improvement of the visual field increased. In the last years more patients with small tumours were treated, and less with medium-sized. Percent of patients with large tumours remains unchanged. The prospective study should be performed to define the proper planning of surgical treatment of large and giant tumours, including two-stages procedures.
Adenoma↗
[Neuropsychological disorders after subarachnoid hemorrhage and surgery in anterior communicating artery brain aneurysms].
In the years 1982-1985 in the Dept. of Neurosurgery of the Jagiellonian University, 197 patients with anterior communicating artery aneurysms were operated on. Excluding multiple aneurysms (9), and taking into account early surgical losses (16), 172 patients were supposed to undergo late medical examinations. The patients were examined by means of questionnaires at least five years after surgery. 43 patients out of the 123 (71.5%) who handed in filled-in questionnaires, underwent psychological examination. Preliminary analysis of the late results of surgery indicates maintenance of the neurological disorders and symptoms. Within the group of examined patients (a neuropsychological examination, Wechsler Scale) it was found that 33 patients had considerable morbid decline in their mental condition and 4 patients moderate. 6 patients were not examined with Wechsler Scale because of aphasia (5 patients) and considerable deterioration of visual acquity (1 patient). The results of the neuropsychological examination showed that the symptoms that predominated were: short memory disorder, a slowdown in psychical and motor functions, conscious concentration disorder, elements of dynamic apraxia and increased tiredness as far as psychical process was concerned. 14 patients (32.6%) resumed work on their former posts, among them the 4 patients who had moderate morbid decline in their mental condition.
Adult↗
[Current diagnostic methods in normotensive hydrocephalus].
Based on literature of the last 30 years we present the current view concerning diagnosis of the communicating hydrocephalus. Till now various methods of the assessment of hydrocephalus have been used in order to select patients for shunt treatment. No single factor, considered apart from the other diagnostic criteria, is sufficient to undertake the decision of shunting. According to current opinion the lumbar infusion test is the most valuable in the assessment of hydrocephalus, supporting us with the data of pressure-volume relations in patient. Based on our own experience the infusion test is not only useful in the preoperative investigation, but also for the assessment of proper shunt function.
Brain↗
Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment.
PURPOSE: To define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery. METHODS: We retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas. RESULTS: Of the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment. CONCLUSION: Profuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.
Adenoma↗
[Diagnosis and surgical treatment of acoustic neurinomas].
The authors present methods of diagnosis and results of surgical treatment of 210 acoustic neurinomas. Almost all patients suffered from large (21.4%) and very large (76.2%) tumours. Results of treatment were assessed depending on the method of surgery (classical and microsurgical), the size of tumour and the method of tumour removal (total or partial). Total tumour removal was achieved in 84.1% of patients operated on by means of microtechnique, and in 72.6% treated with classical method. Very good surgical results were observed in 52.4% and 38.3%, respectively. Difficulties and risk factors in surgery of large acoustic neurinomas were discussed.
Adolescent↗
[Methods of surgical approach to cerebello-pontine angle tumors].
Based on literature and own experience the authors present operative approaches to the tumours of the cerebello-pontine angle. The technique of the suboccipital and supratentorial approach is discussed, its advantages an disadvantages and the risk of complications. Examples of surgical tactics depended on tumour size and the neurological state of the patient are presented.
Cerebellar Neoplasms↗
[Diagnosis and treatment of aneurysms of the lower segment of the vertebrobasilar system].
The authors present 20 patients with aneurysms of the vertebral artery and its branches, treated operatively. The symptomatology and the diagnostic methods in this group of rare vascular abnormalities are discussed. The authors are of the opinion, that there are no specific symptoms typical of this localization. All aneurysms of this group can be treated by suboccipital craniectomy. The results of the operation were good; in 75% the results were good or very good. 20% patients died.
Adult↗
[Immediate and late results of surgical treatment of hydrocephalus after subarachnoid hemorrhage].
During the period from January 1st 1983 up to the end of April 1989 in the Neurology Department and the Neurosurgery Department 1417 patients were treated due to subarachnoidal hemorrhage. Among these patients in 275 cases the inner hydrocephalus was diagnosed using computer tomography (19.4%). In 17 cases (6.2%) hydrocephalus was treated surgically. In all patients the ventricle-atrial Pudenz valve was implanted; in 15 patients the valve was implanted for low pressure and in 2 for moderate pressure. The diagnostics was based on the computed tomography and angiography of cerebral vessels. In all cases large hydrocephalus was diagnosed (the anterior horn index in the computed tomography was below 3.0). The most frequent clinical symptoms were: urine incontinence (15 cases), disturbances of orientation (8 cases), akinetic mutism (8 cases) and paresis of extremities (7 cases). Above symptoms together with radiologic image presented indication for the valve implantation. Very good and good results were obtained in 13 patients, bad results in 2 cases, 2 patients died. Longer observation showed that 6 patients remain in satisfactory state, 3 patients are in bad state and 3 others died.
Adult↗
[Selective denervation of neck muscles in the treatment of spasmodic torticollis. Preliminary results].
The authors present a review of the methods of surgical treatment of spasmodic torticollis, particularly the selective denervation of cervical muscles. Based on the literature and own experience cases treated by means of this method are described. Using selective ramisectomy it is possible to attain permanent improvement in most patients suffering from spasmodic torticollis, with very low complication rate. Our preliminary cases indicates that this method of treatment allows to acquire improvement of quality of life in patients with this particular type of dystonia.
Adult↗
[The usefulness of lumbar infusion test in the evaluation of the intracranial volume pressure compensation in hydrocephalus before and after shunt insertion].
The analysis is presented of selected parameters of the lumbar infusion tests performed in hydrocephalic patients before and after shunt. In properly functioning shunt (50 cases) the mean values of the variables are on an average twice lower than before shunt. In patients with shunt malfunction (surgically verified in 7 out of 10 suspected cases) the values of the parameters are similar before and after shunt and are statistically significant. Lumbar infusion test is proved very useful in the detection of shunt malfunction, particularly when it is possible to compare it to the test performed before shunt.
Aged↗