Effect of DiscoGel treatment of the intervertebral disc at MRI.

AIM: To determine the impact of ethanol gel chemonucleolysis (EGCh) on the radiological picture of the treated intervertebral disc, the relationship between the initial radiological status and the clinical status of the patient after EGCh treatment, and the optimal radiographic criteria for qualifying a patient for EGCh treatment. MATERIALS AND METHODS: The study involved a group of 45 patients (25 men and 20 women) aged 23-68 years (46 ± 11) who underwent an EGCh procedure after qualification, radiography, and clinical questionnaire evaluation. RESULTS: The results showed a decrease in the size of the protrusion and Gadolinium-Enhanced (GI) zone in the treated intervertebral disc. The presence of a high-intensity zone (HIZ) on baseline magnetic resonance imaging was found to be a good predictor of the timing and outcome of treatment, and an increase in disc height was observed in adjacent segments. CONCLUSION: These findings suggest that EGCh is a promising treatment for spine diseases, and the HIZ on baseline magnetic resonance imaging can be used as a qualification criterion for this procedure.

Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology.

PURPOSE: The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS: The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS: The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION: The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

Wavelet assessment of cerebrospinal compensatory reserve and cerebrovascular reactivity.

We introduce a wavelet transfer model to relate spontaneous arterial blood pressure (ABP) fluctuations to intracranial pressure (ICP) fluctuations. We employ a complex continuous wavelet transform to develop a consistent mathematical framework capable of parametrizing both cerebral compensatory reserve and cerebrovascular reactivity. The frequency-dependent gain and phase of the wavelet transfer function are introduced because of the non-stationary character of the ICP and ABP time series. The gain characterizes the dampening of spontaneous ABP fluctuations and is interpreted as a novel measure of cerebrospinal compensatory reserve. For a group of 12 patients who died as a result of cerebral lesions (Glasgow Outcome Scale (GOS) = 1) the average gain in the low-frequency (0.02- 0.07 Hz) range was 0.51 +/- 0.13 and significantly exceeded that of 17 patients with GOS = 2 having an average gain of 0.26 +/- 0.11 with p = 1x10(-4) (Kruskal-Wallis test). A time-averaged synchronization index (which may vary from 0 to 1) defined in terms of the wavelet transfer function phase yields information about the stability of the phase difference of the ABP and ICP signals and is used as a cerebrovascular reactivity index. A low value of synchronization index reflects a normally reactive vascular bed, while a high value indicates pathological entrainment of ABP and ICP fluctuations. Such entrainment is strongly pronounced in patients with fatal outcome (for this group the low-frequency synchronization index was 0.69 +/- 0.17). The gain and synchronization parameters define a cerebral hemodynamic state space (CHS) in which the patients with GOS = 1 are to large extent partitioned away from those with GOS = 2. The concept of CHS elucidates the interplay of vascular and compensatory mechanisms.

[Cranial epidural abscesses: a case report]. / Wewnatrzczaszkowy ropniak nadoponowy: opis przypadku.

OBJECTIVE AND IMPORTANCE: Cranial epidural abscess mostly follows sinusitis or mastoiditis, also open cranial injury or cranial surgery with iatrogenic infection. In our case the abscess possibly evolved from epidural haematoma and the process invaded frontal sinus and subgaleal space in the frontal region. CLINICAL PRESENTATION: A 22-year-old male after motorcycle accident 4 years ago, with signs of sinusitis frontalis and seizures, with CT confirmed epidural abscess. INTERVENTION: Craniotomy was performed and the abscess totally removed. Homogeneous bone was replaced at the operation. Good result, after 2 months without pathologic signs and correct postoperative tomography. CONCLUSION: We conclude on the basis of disease history and clinical evidence, that the most probable was transformation of the abscess from epidural haematoma end in long term period perforated through the frontal bone to the frontal sinus, and to the subgaleal space with signs of sinusitis at last.

[Efficacy of the newest ultrasonographic techniques in intraoperative neurosurgical diagnosis]. / Skutecznosc najnowoczesniejszych technik ultrasonograficznych w sródoperacyjnej diagnostyce neurochirurgicznej.

The contemporary neurosurgery requires efficient methods of intraoperative image guidance. Among some expensive techniques the rather cheap intraoperative ultrasound has been widely accepted in the last decade. The aim of the study is to estimate the efficacy of this technique in the intraoperative evaluation of the different kinds of brain lesions. The authors illustrate it with some ultrasonic images presented in comparison to the images obtained from the preoperative CT or angiography. B-mode ultrasound has proven to be extremely useful for localizing subcortical rather than deep-seated brain tumours, cysts, abscesses as well as intraparenchymal haematomas. The advantages were particularly evident when searching for tumours that were not visible on brain surface. Its use for guidance in cyst or abscess aspiration, as well as usefulness in tumor vascularization estimations (using Power Doppler mode) is outlined. Ultrasound B-mode Color or Power Doppler sonography with high resolution probes offers new possibilities of intraoperative control of neurovascular procedures--either in the localization of small arterio-venous malformations (AVMs) and feeders estimation or for the evaluation of proper clip application in the aneurysm surgery.

[Acute post-traumatic epidural hematoma: report of 4 non-surgically treated cases]. / Ostry pourazowy krwiak nadtwardówkowy--opis czterech przypadków leczonych zachowawczo.

The authors present four cases of acute epidural hematoma (three supratentorial and one in the posterior fossa), in which non-operative treatment was performed. The conditions to undertake this treatment were: good clinical and neurological state of the patients on admission (GCS equal or more than 14), absence or mild focal symptoms and possibility to observe the patients and to perform CT follow-up. All patients had a good recovery. The authors discuss these cases and present the review of the literature concerning the problem.

[The perspectives of ultrasound use in neurological diagnosis]. / Perspektywy stosowania ultradzwieków w neurodiagnostyce.

Ultrasound and Doppler phenomenon constitute the basis of ultrasound diagnostics in neurosciences. They permit to visualize vessel walls and blood flow and allow the quantitative assessment of its velocity and direction. The last years bring the rapid development of these techniques. The introduction of color flow Doppler, power Doppler and Duplex or Triplex ultrasound systems extended the possibilities of ultrasound diagnostics. Thanks to these applications the new non-invasive methods facilitating the assessment of extra- and intracranial vessels and monitoring of blood flow and collateral circulation in many CNS lesions came into being. The authors review the literature concerning this topic.

[Multiple spinal meningeal cysts in the thoracic region associated with lymphedema of the legs (Milroy's disease)]. / Mnogie torbiele nadoponowe w odcinku piersiowym kregoslupa wspólistniejace z zespolem obrzeku limfatycznego konczyn dolnych (choroba Milroya).

Intraspinal extradural meningeal cysts are uncommon cause of spinal compression. Either the classification or the etiopathology of these changes are indistinct in the literature. A rare case of multiple extradural meningeal cysts associated with lymphedema of the legs is presented. The total surgical removal was followed by the quick neurological improvement. Some etiological, diagnostic and therapeutic aspects of these pathologies have been discussed.

Atrial natriuretic peptide secretion following subarachnoid hemorrhage in spontaneously hypertensive rats.

Atrial natriuretic peptide (ANP) is released excessively in spontaneously hypertensive rats (SHR), and vasodepression is its main effect on the blood vessels. The aim of the study was to investigate the changes in ANP secretion in the cerebral vasospasm following subarachnoid hemorrhage (SAH) in SHRs. The SAH was induced by the injection of 100 microliters of unheparinized, autologous blood into the cerebrospinal fluid (CSF), via a canule formerly inserted into the cisterna magna (CM). In the sham SAH group the SAH was imitated with 0.9% saline injection. The concentrations of ANP in the blood samples obtained in the acute and chronic stages of vasospasm were radioimmunoassayed with commercial RIA kits (Peninsula RIK 9103). It was found that both SAH and sham SAH induced a significant increase in plasma ANP in the chronic phase of vasospasm. No such changes were observed in the acute phase. This shows that the chronic cerebral vasospasm following SAH considerably enhances the ANP secretion in SHRs, probably through the increased endothelin release. These compensatory and regulatory mechanisms help prevent the development of brain oedema and the progression of vasopasm through secondary vasodilation.

[Newly formed intracranial saccular aneurysms revealed within several years after surgery for the aneurysm with different localization: report of 2 cases]. / Nowopowstale wewnatrzczaszkowe tetniaki workowate ujawnione w okresie kilku lat od operacji tetniaka o innej lokalizacji--opis 2 przypadków.

The authors present two patients treated surgically for intracranial aneurysms. Within 2.5 and 4.6 years after surgery the repeated angiography performed after the second SAH revealed newly formed aneurysms in another localisation. These facts became a contribution to the etiopathogenetic considerations.

[A case of Morgagni-Morel-Stewart syndrome with violent headaches predominant in the clinical course treated surgically]. / Przypadek zespolu Morgagniego-Morela-Stewarta z bólami glowy dominujacymi w obrazie chorobowym leczony operacyjnie.

The authors present a case of Morgagni-Morel-Stewart syndrome with violent headaches predominant in the clinical course. Surgical removal of hypertrophic frontal bone followed by dura and bone reconstruction was performed. The pains ceased immediately after the operation. The authors discuss surgical treatment especially in cases with high intensity headaches.