The future of spinal cord stereotaxy.

The spinal cord is an integral part of central nervous system, therefore it can be expected that spinal cord has the same properties as the brain. Movement activity is realized by the activation of individual motoneurons of various spinal cord segments under the influence of analytical function of the spinal cord. When a hypothesis is accepted that the mentioned large volume of spinal cord white matter represents the entire length of neuronal network, an idea can be established that the activated motoneurons project through their reticular processes to this connecting network forming a synthetic picture of this movement and after fluent continuity the entire act of movement. Therefore, neuronal network plays the role of dynamic memory.The perspective of spinal cord stereotaxy in functional neurosurgery hypothetically enables a recognition and understanding of how brain and spinal cord communicate in movement performance (Fig. 2, Ref. 6).

The physiological conception of thinking based on the results of psychostereotactic operations.

The authors have gained their experience in psychostereotactic operations during the past 50 years. The operations were indicated in psychiatric patients on the basis of their clinical pictures. The results gained in operations of the hypothalamus, limbic system and neocortical structures of the brain were logically analysed and served as the basis for physiological conception of the function of the nervous system in the area of thinking. The elemental thinking of the hypothalamus resides in relatively simple memory that contains standard values of the internal environment of the body. The immense memory on the highest neocortical level of the human brain grew to become an independent degree of development independent of the objective reality. The entrance of physiological thinking into psychology enables to clarify the aspects of human psychology that are still liable to subjective view, such as emotions, motivation or consciousnesses (Fig. 1, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Considerations on physiological mechanisms of spinal cord movement performance according to cerebral stimuli.

The process of communication between brain and spinal cord remains unclear. Therefore an attempt supported by spinal cord stereotaxy was made to disclose the physiological mechanisms underlying the cooperation between the brain and spine as generated by the spinal cord. The initializing stimulus was the discovery of motoneuron location in all spinal cord segments providing an organic substrate for spinal cord stereotaxy. What remains to be clarified are the anatomical structures of spinal cord, participating in the feedback between brain and spinal cord. Therefore two possible hypotheses were proposed by the authors. One of them is closely related to the analytical synthetical mechanism of real objects and thoughts depiction in the memory of the brain and in form of concrete ideas it forms the basis for concrete thinking. In case of spinal cord another more probable mechanism should be considered: the process of analysis and synthesis between the participating spinal motoneurons. The mutual neuronal spinal cord connections are capable of depicting the movement pattern, and the movement is transferred by means of the described spinal cord pathways to the memory of the brain as a concrete movement idea. From here the ideas are transferred according to the individual needs backwards by means of another described spinal cord pathway back to the spinal cord, and the spinal cord is the final effector. The process of thinking is the physiological correlation of technical software, but in form of abstract thinking it is transferred to the form of abstract thinking. (Fig. 3, Ref 7). Full Text (Free, PDF) www.bmj.sk.

[Reflection on the physiological mechanisms of movements controlled by the spinal cord-brain interaction]. / Uvaha o fyziologickém mechanizmu pohybové reakce uskutecnované míchou na podnety z mozku.

The process of communication between brain and spinal cord remains unclear. Therefore an attempt supported by spinal cord stereotaxy was made to disclose the physiological mechanism underlying the cooperation between brain and spine as generated by the spinal cord. The initializing stimulus was the discovery of motoneuron location in all spinal cord segments providing the organic substrate for spinal cord stereotaxy. What remained to be clarified were the anatomical structures of spinal cord, participating in the feedback between brain and spinal cord. Therefore two possible hypotheses were proposed by the authors. One is closely related to the analytic-synthetic mechanism of real object and thoughts depiction in the memory of the brain and in the form of concrete ideas forming the basis for concrete thinking. In the case of spinal cord, another more probable mechanism should be considered: The process of analysis and synthesis between the participating spinal motoneurons. The mutual neuronal connections in the spinal cord are capable of depicting the movement pattern and the movement is transferred by means of the described spinal cord pathways to the memory of the brain as a concrete movement idea. From here the ideas are transferred according to the individual needs backwards by means of another described spinal cord pathways back to the spinal cord and the spinal cord is the final effector. The process of thinking is the physiological correlate of technical software, but in the form of abstract thinking it is transferred to the form of abstract thinking.

Is interhemispheric arachnoid cyst with corpus callosum agenesis related to cavum vergae cyst?

Authors operated on successfully giant interhemispheric arachnoid cyst associated with corpus callosum agenesis. A conclusion was drawn that this cyst was in fact expansive cavum Vergae cyst, taking into consideration the developmental mechanism responsible for the formation of third ventricle dorsal cysts (Fig. 8, Ref. 10).

Neuroendoscopic management of haematocephalus.

The purpose of the paper was to publish the results of endoscopic treatment of primary and secondary haematocephalus in the group of 23 patients, treated by means of Wolf endoscopic system combined with frame based navigation with the aid of virtual reality environment. The procedure is aimed to remove blood clots from the cerebral ventricles and to reduce the volume of parenchymal haematoma in secondary haematocephalus during single surgical session. In the majority of the treated patients septostomy was added to make revision of both lateral ventricles possible from a single approach, and the operation was completed with endoscopic third ventriculostomy to reduce the amount of blood in the basal cisterns and to reestablish the patency of cerebrospinal fluid pathways, so that lumbar puncture can be safely done to facilitate the process of cleaning blood away from the cerebrospinal fluid. The surgery always facilitates the resorption of residual blood as well as blood degradation products, therefore late complications, such as posthaemorrhagic hydrocephalus, membranes and stenosis formation was prevented. Improvement of the clinical condition was obtained without the need for permanent drainage systems insertion. Lethal outcome in one patient and unfavourable clinical result in another three patients were unrelated to the endoscopic treatment. (Tab. 1, Fig. 2, Ref: 10.)

On the rupture of an aneurysm.

The intracranial aneurysm, with an estimated occurrence of up to 4% in the general population, belongs among the most dangerous of cerebrovascular diseases. Although less than one-fifth of these cases results in a subarachnoid haemorrhage, the resulting disability and mortality rate is too high. More understanding is needed regarding aneurysm rupture and its deleterious effects. This study presents a physiologically-feasible explanation for the development of an enormous haemodynamic stress in the vicinity of the aneurysm in the cerebrovascular bed. Using a computer circulation model, this build-up of pressure was developed by sequentially imposing a series of interventions on the normal system.

Critical remarks on the stereotaxic treatment of epilepsy.

The analysis of experiences with 43 patients treated stereotaxically for epilepsy, shows that the stereotaxic method can play an important role 1) in the investigation of the structures in epileptic activity; 2) in proper management of these cases. According to deep electrode records, the epileptic focus seems to be like a system of anatomical structures, which are functionally interdependent, and its relationship can be plotted on a schematic graph, which must be calculated in the strategy of treatment with the combined performances. In spite of this results are not satisfactory. New methodological approaches should be devised, such as longitudinal stereotaxic hippocampectomia, which is suggested as promising.

[Stereotactically aimed biopsy of vertebral body l2.]. / Stereotakticky cílená biopsie z obratlového tela L2.

The authors describe successful use of an whole-body stereotactic apparatus for collection of pathological tissue samples from the vertebral body L2. Key words: whole-body aiming apparatus, stereotactic biopsy, vertebral body.

The function of the cerebrospinal fluid space and its expansion.

In addition to its nutritive and protective effects, the basic function of the cerebrospinal fluid space resides in dynamic equilibration of pressure fluctuations caused by volume changes in three compartments contained within the rigid skull cavity: brain tissue, blood and cerebrospinal fluid. An increase in volume in one of them brings about a compliant withdrawal in volume in the other two. The degree of cerebrospinal fluid compliance can be expressed by means of the pressure/volume index which is directly proportional to this compliance. On the other hand an expansion of fluid space which forces the brain to withdraw its tissue, brings about the dilatation of brain ventricles. The degree of their dilatation depends on the effective pressure of cerebrospinal fluid which counteracts with the resistance of brain venous collectors. The blood in the venous network of the brain and cerebral extracellular fluid play a reversible role in cerebral mass restoration and reduction. These facts explain the reason why, from the physical point of view, the brain is considered to represent a viscous and elastic spongious matter. (Ref. 21.)

Stereotactic evacuation of spontaneous infratentorial hemorrhage with monitoring of intracerebral pressure.

INTRODUCTION: Based on our experience with stereotactic evacuation of spontaneous supratentorial hematomas this method has also been used for evacuation of spontaneous infratentorial hematoma by the transtentorial approach. MATERIAL AND METHOD: The authors present a series of 6 patients with spontaneous intracerebral hematomas evacuated by the frame-based stereotactic technique, with monitoring of intracranial pressure (ICP) during the stereotactic evacuation. This method was indicated in patients with stable neurological status according to Glasgow Coma Scale (GCS), more than 10. The frame-based stereotaxy with the Riechert-Mundinger apparatus with CT localisation of target and optimal trajectory was used. RESULTS: The presented values after stereotactic evacuation show reduction of the initial intraparenchymal ICP in all patients to values less than 20 mmHg. CONCLUSION: The measuring of the ICP and the analysis of dynamic changes during stereotactic evacuation suggest that this procedure can significantly reduce the ICP performed in connection with ICH and we believe that our results can improve management of patients with spontaneous infratentorial and supratentorial intracerebral hematoma. (Fig. 1, Ref. 21.).

[Neurosurgery--an instrument for stereotaxic surgery]. / Neurochirurgia--stereotaktický operacný prístroj.

The authors presents their experiences with simple stereotactic instrument. There are presented possibilities of using stereotactic equipment, when taking aut biopsy, from deep structures of brain, evacuation of cerebral hematoma, aspiration of the brain abscess and stereotactic quidance resection of tumor in functionally important parts of brain.

[Development of European medicine to the time of Vesalius (16th century)]. / Vývoj evropské medicíny do Vesalia (16. století).

Mythical Greece, Egyptian Alexandria and ancient Rome were the cradle of ancient medicine where the beginnings of anatomy and physiology were combined with nature philosophy of great personalities such as Hippocrates and Galen. A modern contribution i.e. medical chemistry, to European medicine was made by Arab physicians Rhazes and Avicena. Only when clerical dogmatism was overcome, after the discovery of the New world and the development of universities the road to scientific progress ws opened on which started the great surgeon and physician Andreas Vesalius.

[Computer tomography in functional stereotactic neurosurgery]. / Vyuzití výpocetní tomografie ve funkcní stereotaktické neurochirurgii.

The authors describe their own modification of visualization and construction of coordinates of a stereotactic object for functional stereotaxis controlled by computed tomography (CT). This method was applied so far in four functional stereotactic operations (twice for parkinsonian tremor, once for retrocollis and once for epilepsy). In three patients where coagulation of the surgical objective was made, on the 4th or 5th day after operation there was a check-up CT examination and the size and character of the lesion was evaluated. Based on their own experience and reports in the literature, the authors emphasize the advantages of CT as compared with formerly used ventriculography in the control of functional stereotactic operations.

[Cerebral ischemia and neuroprotection from the viewpoint of the neurosurgeon]. / Mozková ischémie a moznosti neuroprotekce z pohledu neurochirurga.

Cerebral ischemia is a frequent and dangerous consequence of some cerebrovascular diseases. Ischaemia may be used also electively in the course of neurosurgery. Therefore new possible ways are sought how to reduce the danger of ischaemia or to prevent it. In the submitted paper some methods of neuroprotection are described and their potential or actual applicability in clinical neurosurgery are discussed. In addition to influencing the brain cell and pretentious methods in the sphere of molecular biology and genetics the induction of systemic hypertension supplemented alternatively by other methods such as hypothermia, the use of mannitol, haemodilution and hypervolaemia seem natural. A higher blood pressure helps to make leptomeningeal and cortical anastomoses patent and strengthens the collateral circulation from marginal zones of ischaemia, penumbra to the ischaemic centre and to prevent thus cerebral infarction.

[Transplantation of embryonal nerve tissue into the brain of donors under experimental and clinical conditions]. / Transplantace embryonální nervové tkáne do mozku príjemce v pokusných a klinických podmínkách.

The authors, stimulated by the results of transplantations of embryonic nervous tissue under experimental conditions and by findings on the biochemical background of some manifestations of mental diseases, dared to use for the first time transplantation of portions of human embryonic brain in the treatment of schizophrenia. Before the experiment they evaluated the bilateral xeno as well as autotransplantations in ten cats. Under clinical conditions they used transplantation of embryonic nervous tissue in two patients with the acute and chronic form of schizophrenia. The operation was performed, using Mundinger's stereotactic apparatus controlled by a computer. The tissue from the central portion of the embryonic brain from the 5th and 7th week of gestation with a high serotonin content was deposited bilaterally in the septal area in the recipient's brain. They recorded improvement in particular in a case of acute schizophrenia. By monitoring the foci of transplanted tissue by computed tomography and magnetic resonance, they provided evidence that embryonic nervous tissue is incorporated in the recipient's brain without reverting into malignant growth and that it is not rejected by the immune system of the recipient.

[Directed photonucleolysis of the intervertebral disk and its herniation. Preparation for percutaneous laser diskectomy]. / Cílená fotonukleolýza intervertebrálního disku a jeho výhrezu. Príprava k laserové perkutánní diskektomii.

Under model conditions it proved possible, using a whole-body stereotactic apparatus, to focus on a human intervertebral disc and its prolapses and eliminate them by photocoagulation, using a laser. The suitable cannulae have a 3 mm diameter and an output of 6 to 12 W. The necessary lesion is reached in a fractionated manner within 1 minute. Thus the conditions were created for the new technique of percutaneous disectomy which has been done hitherto by means of chemical substances or mechanically by incision and suction.

[A multipurpose vacuum mattress in health care]. / Viaceúcelové pouzitie vakuového matraca v zdravotníctve.

The authors draw attention to vacuum mattresses which are a modern appliance for the immobilization of casualties and patients. They present their initial experience with the use of these mattresses during examinations on a computed tomograph, during all-body stereotaxis and minor surgical operations. The material from which the mattress is made allows X-rays to penetrate, therefore it can be used also for immobilization of restless patients and children during X-ray examinations. It is, however, possible to manufacture also various types of vacuum splints for fixation of the extremities after injuries.

[Stereotaxic therapy of post-traumatic cerebral hemorrhage]. / Stereotaktická lécba poúrazových mozkových krvácení.

The authors present five case-histories pertaining to stereotactic evacuation of lobar traumatic cerebral haematomas and indicate new ways of their treatment. It ensure already from initial observations of the authors that stereotactic operation of these haemorrhages is justified and useful in haematomas affecting several cerebral lobes simultaneously or in case of symmetrical haematomas.