Comparison of Navigated and Frame-Based Stereotactic Biopsy-A Single-Center Cohort Study.

Background and Objectives: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. Materials and Methods: retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. Results: The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples (p < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. Conclusions: Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.

Decompressive hemicraniectomy in ischaemic stroke.

BACKGROUND AND PURPOSE: Hemispheric ischaemic stroke complicated by oedema is associated with high mortality. The results of randomized studies showed that decompressive hemicraniectomy performed in this group of patients could be beneficial. First experiences with implementation of hemi-craniectomy in patients with brain infarct in our stroke centre are presented. MATERIAL AND METHODS: Between August 2007 and July 2008, four patients with hemispheric brain infarcts complicated by malignant oedema underwent decompressive hemicraniectomy within 72 hours from symptoms onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed 3, 6 and 12 months after the event using the modified Rankin scale (mRS). RESULTS: In the first patient, the neurosurgical procedure included only decompressive hemicraniectomy, whereas in the other three duraplasty was performed additionally. The first patient died 23 days after the stroke onset due to acute respiratory failure. Another died at four months after the event, due to infectious complications. The remaining two patients presented severe functional disability 12 months after the procedure (mRS score 4). CONCLUSIONS: Decompressive surgery with duraplasty can be a life-saving procedure for patients with brain oedema. To our knowledge, the presented cases are among the first reported cases of hemispheric ischaemic stroke treated with decompressive hemicraniectomy in Poland. Extended follow-up with a larger group of patients is necessary to assess long-term outcome.

[The evaluation of the brain arteriovenous malformations' operative treatment in the clinical material of Silesian Medical University's Departament of Neurosurgery]. / Ocena wyników operacyjnego leczenia naczyniaków tetniczo-zylnych mózgu w materiale Kliniki Neurochirurgii w Katowicach.

UNLABELLED: A risk of haemorrhage in arteriovenous malformations (AVM) of the brain is estimated as 2-4% per year. A mortality rate from this reason is estimated as 1% per year and morbidity 10-20%. The methods of treatment ofAVM are: microsurgical treatment, radiosurgery, endovascular treatment. The aim of this work is presentation of our results of surgical treatment of AVM and comparison with the results of radiosurgical and endovascular treatment presented by other authors in the literature. MATERIAL AND METHODS: Between 1990-2002 in the Department of Neurosurgery of Medical University of Silesia in Katowice 31 patients were operated with AVM's of the brain. Among them there were 10 female and 21 male at the age from 10 to 69 years. The average age was 36.1. The first sign was intracranial haemorrhage in 19 cases and epileptic seizures in 9 cases. In all cases the cerebral angiography was performed and all patients were assessed as I to III score according to the Spetzler-Martin scale. All patients were operated on using microneurosurgical techniques. The total removal of the tumour was assessed using the intraoperative Doppler examination. The state of the patients at the discharge was estimated according to Glasgow Outcome Scale (GOS). RESULTS: In all cases the malformations were removed totally. In 2 cases (6.4%) we noticed the deterioration of neurological condition after operation. The state of 28 patients (90.3%) was assessed as very good and good (I or II score) according to GOS at the discharge. We didn't notice any mortality in our group of patients. CONCLUSIONS: In the conclusion we want to emphasize the advantages of surgical treatment of AVM's of the brain especially these including in I to III score according to Spetzler-Martin scale comparing with the results ofradiosurgical and endovascular methods of treatment.

[Endoscopic transsphenoidal treatment of pituitary adenomas]. / Endoskopowe leczenie gruczolaków przysadki.

BACKGROUND AND PURPOSE: The aim of this study is to present a new endoscopic transnasal transsphenoidal method of surgical treatment of pituitary adenomas and to evaluate the results and complications of the method. MATERIAL AND SURGICAL TECHNIQUE: From October 2001 to June 2003 in the Department of Neurosurgery of the Medical University of Silesia in Katowice 88 operations of pituitary adenomas were performed using the transnasal transsphenoidal endoscopic method. The group of patients consisted of 50 females and 38 males. The youngest patient was 11 years old and the oldest was 79 years old. Patients were operated on using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using a method of operation according to Jho and Carrau with own modifications. At the time of surgery the operation team included 2 neurosurgeons, an anesthesiologist and a laryngologist. RESULTS: In the group of 51 nonfunctioning adenomas, in 32 cases we obtained the total removal of the tumor, which amounts to 63%. Among 37 of hyperfunctioning adenomas there were 11 prolactinomas, 19 GH secreting adenomas and 7 ACTH secreting adenomas. In all cases of prolactinomas the tumor was removed totally and in the cases of GH secreting adenomas and ACTH secreting adenomas the total removal of the tumor was performed in 58% and 86% of the cases, respectively. One patient within our group died after the operation. It was the patient with a huge nonfunctioning macroadenoma, with hydrocephalus and preoperative disturbances of consciousness. The permanent diabetes insipidus occurred in 2 cases, which amounts to 2.3% of all operated patients. In this group we noticed the intraoperative CSF leakage in 20 cases but we did not observe the postoperative CSF leakage or any rhinological complications. CONCLUSIONS: The endoscopic transnasal transsphenoidal approach is an efficient method of surgical treatment of pituitary adenomas. The advantage of this method is low invasiveness and a small number of serious complications.

Simultaneous radiotherapy and radioimmunotherapy of malignant gliomas with anti-EGFR antibody labelled with iodine 125. Preliminary results.

BACKGROUND: In this paper we present the preliminary results of a prospective trial of the efficacy of simultaneous radiotherapy and anti-EGFR (125)I radioimmunotherapy of malignant gliomas with 2 years' total survival as the end-point, raising the question whether anti-EGFR (125)I radioimmunotherapy influences the disease-free survival in these patients. MATERIAL AND METHODS: Patients with anaplastic astrocytoma or primary glioblastoma were previously treated by a macroscopically radical neurosurgical approach and randomized either to radiotherapy + radioimmunotherapy arm or treated by radiotherapy alone. Seven patients were included in the group with radioimmunotherapy, among them five with GBM and two with AA, and five patients in the control arm. Patients were irradiated to 60 Gy using three-dimensional conformal noncoplanar techniques. Anti-EGFR (125)I monoclonal antibody 425 radioimmunotherapy (50 mCi/course) was started during 4th week of radiotherapy and was repeated three times in one week intervals. RESULTS: Time of follow-up ranges between 2 and 10 months in the anti-EGFR (125)I radioimmunotherapy arm and 4 and 9 months in the control arm. Recurrence was diagnosed in all patients in the EGFR (125)I group with a lethal outcome in two of them and in 4 patients in the control group. Median time to recurrence was 2 and 5 months respectively. CONCLUSIONS: Taking into account early recurrences observed, we propose to continue the studies on the efficacy of adjuvant anti-EGFR (125)I radioimmunotherapy in a selected group of patients in whom the greatest benefit may be expected on the basis of molecular studies, among them EGFR expression investigation.

[Otoneurologic symptoms associated with Arnold-Chiari syndrome type I]. / Objawy otoneurologiczne wystepujace w typie I zespolu Arnolda-Chiari.

This study presents two cases of Arnold-Chiari malformation type I. In a 26-year old man, right side deafness and left side sensorineural hearing loss at high frequencies occurred. Another patient, a 48-year old man also complained of sensorineural hearing loss and dizziness, that appeared a year and half ago. In addition, this patient had episodes of vertigo with nausea and vomit that occurred about one year before main symptoms. In both patients ENT examinations were performed as well as an audiological diagnostic battery including tonal- and impedance-audiometry, auditory brainstem responses, distortion product otoacoustic emissions and electroencephalography. Magnetic resonance imaging (MRI) showed pathological changes in the cerebello-pontine angle region that allowed diagnosing Arnold-Chiari malformation in both cases. Additionally, angio-MRI performed in patient with right side deafness revealed cochleovestibular nerve compression syndrome on the same side. Presumably, both anomalies occurring simultaneously in this patient might be responsible for deafness in the right ear, instead of mild or moderate hearing loss and tinnitus usually expected according to the literature. The paper presented two cases of Arnold-Chiari malformation with co-existing cochleovestibular nerve compression syndrome in one case. The importance of both audiological diagnostic battery and MRI in diagnostic procedures of this malformation has been demonstrated.

Use of monoclonal anti-EGFR antibody in the radioimmunotherapy of malignant gliomas in the context of EGFR expression in grade III and IV tumors.

We investigated the putative benefits of simultaneous teleradiotherapy and anti-epidermal growth factor receptor (EGFR) 125I monoclonal antibody (MAb) 425 radioimmunotherapy, when applied after neurosurgery in high-grade gliomas, over teleradiotherapy alone. In comparison to previous studies which have reported good results with this type of radioimmunotherapy, we advanced the adjuvant radioimmunotherapy step, that is, gave it during, not after, teleradiotherapy. The randomized prospective study examined two groups: simultaneous postoperative teleradiotherapy and radioimmunotherapy (TRT + RIT; eight patients) versus teleradiotherapy alone (TRT; 10 patients). Patients who after primary operation of grade III (6 cases) or IV glioma (12 cases), showed no or less than 2 mL of remnant tumor on post-operative magnetic resonance (MR) study and were not treated postoperatively by chemotherapy were enrolled and randomized. Anti-EGFR 125IMAb 425 RIT was started during week 4 of radiotherapy, not later than 8 weeks after neurosurgery, and was repeated three times at 1-week intervals. Total activity given was 5026 + 739 MBq/patient. The tolerance of TRT was good. No immediate side effects of concomitant anti-EGRF 125I RIT were observed. Observation showed a median total survival (as evaluated from the primary neurosurgical treatment) of 14 months (range 3.5-28 months). There was no improvement in disease-free or total survival in the group of patients treated by TRT + RIT after neurosurgery. In addition, an immunohistochemical analysis of EGFR expression in gliomas was performed in a group of 100 cases and was distinctly positive in 50% grade IV gliomas and 68% grade III gliomas. We conclude that simultaneous radiotherapy and radioimmunotherapy with anti-EGFR 125I-MAb 425 is not beneficial over radiotherapy alone in adjuvant treatment of high-grade gliomas after neurosurgery. We also recommend individual confirmation of EGFR expression in further anti-EGFR radioimmunotherapy trials.

Changes in cerebral hemodynamics assessed by transcranial Doppler ultrasonography in children after head injury.

INTRODUCTION: Head injury is an important factor in children's morbidity and mortality. Arterial vasospasm and probably resulting from this, delayed ischemic deficit are important sequels of head trauma with detrimental effects on outcome. These problems have already been well studied in adults, but not in children. The noninvasiveness and ease in use of transcranial Doppler ultrasound technique (TCD) make it an ideal tool for the assessment of changes in cerebral circulation not only for the purposes of diagnosis but also for follow-up. PATIENTS AND METHODS: The authors review the present literature and analyze the usefulness of TCD as used in a group of 27 head-injured children aged 3-16 years. GCS/CCS score, CT pictures and neurological status were estimated. TCD examination was performed on the 2nd day after injury and each of the following 5 days or until normalization of flow velocities. Blood flow velocity was measured in the middle cerebral artery, the anterior cerebral artery and the extracranial portion of the internal carotid artery. The pulsatility index was also read. RESULTS: A significant correlation was found between changes in blood flow parameters and neurological status. High blood flow velocities seemed to be caused by hyperemia rather than by vasospasm. CONCLUSION: The results confirm that TCD is a useful method in the management of children after head injury.