Cerebrospinal Fluid and Serum Biomarker Insights in Aneurysmal Subarachnoid Haemorrhage: Navigating the Brain-Heart Interrelationship for Improved Patient Outcomes.

The pathophysiological mechanisms underlying severe cardiac dysfunction after aneurysmal subarachnoid haemorrhage (aSAH) remain poorly understood. In the present study, we focused on two categories of contributing factors describing the brain-heart relationship. The first group includes brain-specific cerebrospinal fluid (CSF) and serum biomarkers, as well as cardiac-specific biomarkers. The secondary category encompasses parameters associated with cerebral autoregulation and the autonomic nervous system. A group of 15 aSAH patients were included in the analysis. Severe cardiac complications were diagnosed in seven (47%) of patients. In the whole population, a significant correlation was observed between CSF S100 calcium-binding protein B (S100B) and brain natriuretic peptide (BNP) (rS = 0.62; p = 0.040). Additionally, we identified a significant correlation between CSF neuron-specific enolase (NSE) with cardiac troponin I (rS = 0.57; p = 0.025) and BNP (rS = 0.66; p = 0.029), as well as between CSF tau protein and BNP (rS = 0.78; p = 0.039). Patients experiencing severe cardiac complications exhibited notably higher levels of serum tau protein at day 1 (0.21 ± 0.23 [ng/mL]) compared to those without severe cardiac complications (0.03 ± 0.04 [ng/mL]); p = 0.009. Impaired cerebral autoregulation was noted in patients both with and without severe cardiac complications. Elevated serum NSE at day 1 was related to impaired cerebral autoregulation (rS = 0.90; p = 0.037). On the first day, a substantial, reciprocal correlation between heart rate variability low-to-high frequency ratio (HRV LF/HF) and both GFAP (rS = -0.83; p = 0.004) and S100B (rS = -0.83; p = 0.004) was observed. Cardiac and brain-specific biomarkers hold the potential to assist clinicians in providing timely insights into cardiac complications, and therefore they contribute to the prognosis of outcomes.

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience.

Considering the variety of complications that arise after aneurysmal subarachnoid haemorrhage (aSAH) and the complex pathomechanism of delayed cerebral ischaemia (DCI), the task of predicting the outcome assumes a profound complexity. Therefore, there is a need to develop early predictive and decision-making models. This study explores the effect of serum biomarkers and clinical scales on patients' outcomes and their interrelationship with DCI and systemic complications in aSAH. This was a retrospective analysis including aSAH patients admitted to the Wroclaw University Hospital (Wroclaw, Poland) from 2011 to 2020. A good outcome was defined as a modified Rankin Scale (mRS) score of 0-2. The prediction of the development of DCI and poor outcome was conducted using logistic regression as a standard model (SM) and random forest as a machine learning method (ML). A cohort of 174 aSAH patients were included in the analysis. DCI was diagnosed in 79 (45%) patients. Significant differences between patients with poor vs. good outcome were determined from their levels of albumin (31 ± 7 vs. 35 ± 5 (g/L); p < 0.001), D-dimer (3.0 ± 4.5 vs. 1.5 ± 2.8 (ng/mL); p < 0.001), procalcitonin (0.2 ± 0.4 vs. 0.1 ± 0.1 (ng/mL); p < 0.001), and glucose (169 ± 69 vs. 137 ± 48 (nmol/L); p < 0.001). SM for DCI prediction included the Apache II scale (odds ratio [OD] 1.05; 95% confidence interval [CI] 1.00-1.09) and albumin level (OD 0.88; CI 0.82-0.95). ML demonstrated that low albumin level, high Apache II scale, increased D-dimer and procalcitonin levels had the highest predictive values for DCI. The integration of clinical parameters and scales with a panel of biomarkers may effectively facilitate the stratification of aSAH patients, identifying those at high risk of secondary complications and poor outcome.

Direct Vertebral Rotation (DVR) Does Not Improve Clinical and Radiological Results Compared to Differential Rod Contouring (DRC) in Patients Treated Surgically for Idiopathic Scoliosis.

Direct vertebral rotation (DVR) is the most widespread method to correct axial vertebral rotation. Differential rod contouring (DRC) also includes derotation, but not to the same extent as DVR. DVR requires additional surgical effort with potential consequences, which are absent in DRC; moreover, the data concerning the clinical benefits of apical derotation are not convincing. In the present study, clinical and radiological outcomes were compared in patients who underwent surgery for adolescent idiopathic scoliosis (AIS), having DVR and DRC vs. DRC only. In total, 73 AIS patients with curves of 40-85°, consecutively operated on by one surgeon, participated in this study and were followed up over 2 years. Scores from the SRS-22 questionnaire were analysed, the angles of trunk rotation (ATR) were measured with an inclinometer and a radiographic assessment of coronal and sagittal spinal profiles was conducted. In 38 cases, only DRC was performed, and in 35 DRC was performed and followed by DVR; the groups did not differ from an epidemiological point of view. Total SRS-22 scores after 2 years were similar in both groups (4.23 (±0.33) in DRC vs. 4.06 (±0.33) in DRC/DVR, p = 0.1). In all components of SRS-22, the differences were minor, with p being way above 0.05. The mean ATR in the DRC/DVR group was slightly smaller (8 ± 4°) than that of the DRC group (10 ± 5°), p = 0.16. Radiographic analysis did not show significant differences. The coronal curve was corrected by 66 ± 12% for DRC and 63 ± 15% for DVR, p = 0.28. Thoracic kyphosis in the DRC/DVR group increased by 1°, whereas in the DRC group the average kyphosis increased by 5° with a p value of 0.07. The complication rates were similar in both groups. This investigation did not show any advantages of the combination of DRC and DVR in scoliosis correction over DRC only, both radiologically and clinically, yet it affected intraoperative parameters, extending the operation time with only a minor increase in blood loss.

Surgical Treatment of Spinal Fracture in a Patient With Ankylosing Spondylitis: An Opportunity To Correct Spinal Deformity Simultaneously With Fracture Fixation?

The objective of this case report is to describe the substantial sagittal correction of spinal hyperkyphosis alongside fracture fixation. In advanced ankylosing spondylitis (AS), the spine is usually fused, hyperkyphotic, and due to deformity, as well as improper bone remodeling, predisposed to fractures. These fractures, mostly unstable, require surgical treatment. The authors present fracture management with concomitant deformity correction at the fracture site and pedicle subtraction osteotomy (PSO) below the fracture, showing the benefits of performing the procedures with the patient in a sitting position. A 58-year-old male with AS was diagnosed with a fracture of C6 and referred to the department of neurosurgery, Wroclaw University Hospital. For the last week, he had complained of worsening neck pain and exacerbation of spinal kyphosis, with no neurological deficits. The patient had a fully fused spine, significant hyperkyphosis prior to the injury, and a fracture with an additionally exacerbated deformity. The patient was offered operative treatment - spinal fusion and fracture reduction with hyperkyphosis correction. The procedure consisted of 1) partial, mostly closed correction at the fracture site, 2) PSO of C7 and C2-T3 pedicular fixation and fusion while sitting in the posterior approach. To enable closed reduction at the fracture site and avoid difficulties with positioning a prone patient with very severe hyperkyphosis and an unstable spine, the authors performed surgical procedures with the patient in a sitting position. The authors obtained significant correction during the procedure by 740, from 53.40 of kyphosis to 24.30 of lordosis measured between C2 and T1. The patient had several complications (transient weakness of the upper limb, pleural effusion, and delayed wound healing); however, all resolved and the patient was discharged within two weeks post the operation. In patients with spinal hyperkyphosis with AS who sustain spinal fractures requiring operative treatment, it is worth considering simultaneous correction of the spinal deformity during surgical management of the fracture.

A Comparative Biomechanical Analysis of the Impact of Different Configurations of Pedicle-Screw-Based Fixation in Thoracolumbar Compression Fracture.

The aim of this experimental study was to analyze the impact of applying different configurations of the transpedicular fixation system on selected mechanical parameters of the thoracolumbar spine under conditions of its instability (after simulated fracture). Five study groups were tested: physiological, with compression fracture of the vertebra, with two-segment fixation, with three-segment fixation, and with four-segment fixation. Each of the analyzed study groups was subjected to axial compression, flexion, and extension. Based on the conducted experimental tests, the mechanical parameters, i.e., stiffness coefficient and dissipation energy, were determined for all groups under consideration. The stiffness value of two-segment fixation is significantly lower than the physiological value (during flexion and extension). The use of long-segment fixation considered in two configurations (three- and four-segment fixation) may result in excessive stiffness of the system due to the high stiffness values achieved (approx. 25-30% higher than the physiological values in the case of compression and on average 60% higher in the case of flexion). The use of long-segment fixator design shows better results than short-segment fixation. Considering both biomechanical and clinical aspects, three-segment fixation seems to be a compromise solution as it saves the patient from more extensive stiffening of the spinal motion segments.

Minimal invasive posterior correction of Lenke 5C idiopathic scoliosis: comparative analysis of minimal invasive vs. open surgery.

INTRODUCTION: Surgical management of adolescent idiopathic scoliosis in spite of usually favourable outcomes is still a major operation. Therefore, efforts are being undertaken to minimalize the procedure, reduce the surgical trauma and postoperative convalescence. The study was designed to compare posterior minimal invasive surgery using navigation based on intraoperative 3D imaging and standard open instrumented fusion in Lenke 5C idiopathic scoliosis treatment. MATERIALS AND METHODS: From eight patients with Lenke 5C curves planned for posterior correction and instrumented fusion, four were treated with minimally invasive and four had open procedure. Operation length, estimated blood loss, number of fusion levels, days of opioid intake, length of hospital stay and radiation doses required were noted. Radiographic assessment of spinal curvatures was performed (magnitude, flexibility, sagittal alignment). The comparison of the data was done between open and minimally invasive treated patients. RESULTS: In minimally invasive surgery group, the operations were longer on average 285 min ± 47.5 than in the open surgery group, 242.5 min ± 44.5 (p = 0.371) and resulted in slightly inferior coronal curve correction by 68.25% ± 6.2 vs. 78.25% ± 8.8, respectively (p = 0.072). We observed a clear reduction of intraoperative blood loss in minimally invasive patients (mean 138.75 ± 50 vs. 450 ± 106 ml, p = 0.016), shorter hospital stay, average 3.75 vs. 7 days (p = 0.043) and lower opioid requirements postoperatively - 2 vs. 3.25 days (p = 0.015). CONCLUSIONS: The minimally invasive approach to idiopathic scoliosis treatment is a very promising technique to limit the extent of surgery maintaining the same goals as in the open method. It allows for lower blood loss, less requirement for opioids and a shorter hospital stay.

Steroids in Acute Spinal Cord Injury: All But Gone Within 5 Years.

BACKGROUND: Spinal cord injury (SCI) is a devastating event often leading to poor neurologic outcomes. One of the most widely practiced treatments has been the administration of methylprednisolone. However, today its use has been called into question over concerns of efficacy and safety. The present study evaluated the changes in the practice of steroid administration in acute SCI among members of the National Spinal Society in Poland in comparison with the results of the survey conducted in 2013. METHODS: The questionnaire, comprising 5 questions, was distributed among 240 spinal surgeons, members of the Polish Society of Spinal Surgery; of these, 97 (40%) responded. The results were compared with data from the previous survey conducted in 2013. RESULTS: Over a period of 5 years, the prevalence of steroid administration in acute SCI has completely reversed; the proportion of steroid users declined from 73% to 27%. The main rationale for using it was belief in efficacy, rather than fear of litigation. The differences between specialization and age groups were not statistically significant in both administrations. CONCLUSIONS: A significant decrease was observed in the number of surgeons using steroids in the acute SCI, similar to that reported in the literature. The critical appraisal of the existing clinical evidence, as well as the formulation of guidelines by professional organizations, exerted a profound impact on the practice pattern.

The change of volume of the lumbar vertebrae along with aging in asymptomatic population: a preliminary analysis.

INTRODUCTION: Previous studies have demonstrated that the length of the lumbar spine is decreasing with age. Despite considerable research based on sagittal measurements, little is known about the changes in the volume of vertebrae. The objective of this study was to evaluate the changes in the volume of either column of the spine with age. MATERIALS AND METHODS: Computed tomography scans of 62 asymptomatic subjects, performed for thoracolumbar trauma evaluation were used to create virtual 3D models. At least 10 patients were assigned to every decade of life from third to eight. We used a novel technique to measure the volume of anterior column (AC) and posterior column (PC) per each segment (a total of 310 segments). Midline sagittal images were used to measure disc height (DH) and vertebral body height (VH). RESULTS: With age, both DH increases, whereas the VH decreases. The overall length of lumbar segment of the spine decreases with age. The volumetric measurements performed on same subjects showed that volume of both AC and PC does not change with age in females. In males, there is a weak but statistically significant correlation between AC volume and age and no change in the volume of PC. The ratio of PC:AC volume does not change with age in women, although it decreases slightly but significantly (in favor of AC) with age in males. CONCLUSIONS: The overall length of lumbar spine decreases with age. This process is not a result of mere changes in the volume of either AC or PC.

Increased Radiation but No Benefits in Pedicle Screw Accuracy With Navigation versus a Freehand Technique in Scoliosis Surgery.

BACKGROUND: The clinical value of pedicle screws in spinal deformity surgery is well known; however, screw insertion is demanding and sometimes associated with complications. Navigation systems based on intraoperatively obtained three-dimensional (3-D) images were developed to minimize pedicle screw misplacements. However, there is a lack of data confirming superiority of navigation above other techniques. There are also concerns regarding increased radiation used during the procedure. QUESTIONS/PURPOSES: The purposes of this study were (1) to compare accuracy of the two methods of pedicle screws placement: intraoperative 3-D image navigation versus a freehand technique in patients with idiopathic scoliosis; and (2) to assess the radiation dose received by patients with both methods. METHODS: Between 2014 and 2016, 49 patients underwent posterior spinal fusion with all pedicle screw constructs for idiopathic scoliosis performed by two surgeons. The study design involved alternating the use of the freehand technique and navigation to position pedicle screws in consecutive patients, forming groups of 27 patients with 451 navigated screws and 22 patients with 384 screws positioned freehand. The two groups did not differ in age, sex, or magnitude of deformity. Two observers not involved in the treatment evaluated the position of the screws. The pedicle breach was assessed on intraoperatively obtained 3-D O-arm® scans according to a grading system: Grade 0 = no pedicle wall violation; Grade 1 = perforation ≤ 2 mm; Grade 2 = 2 to 4 mm; and Grade 3 = perforation > 4 mm. Grades 0 and 1 were considered properly positioned and Grades 2 and 3 represented malposition. RESULTS: In terms of accuracy, we found no differences, with the numbers available, between the freehand and navigated groups in terms of the proportion of screws that were properly positioned (96% freehand and 96% in the navigation group, respectively; p = 0.518). Grade 3 pedicle screws were observed only in the freehand group and were all located in the upper thoracic spine. Patients undergoing navigated pedicle screw placement received a greater mean radiation dose than those whose screws were placed freehand (1071 ± 447 mGy-cm versus 391 ± 53 mGy-cm; mean difference, 680 mGy-cm; 95% confidence interval, 217-2053 mGy-cm; p < 0.001). CONCLUSIONS: In patients with moderate idiopathic scoliosis undergoing primary surgery, we did not observe benefits of pedicle screw placement with CT-based navigation, but the patients experienced greater exposure to radiation. LEVEL OF EVIDENCE: Level III, therapeutic study.

Traumatic brain injury in Poland from 2009-2012: A national study on incidence.

BACKGROUND: Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity worldwide. The purpose of this study was to provide data on epidemiology of TBI in Poland during 2009-2012. METHODS: The national data on hospitalizations with TBI as a primary diagnosis was obtained from the National Health Fund of Poland. The sub-set of two diagnosis-related groups (DRG) was used for analysis. The incidence and mortality were calculated with the emphasis on diagnosis. The external causes of injuries were investigated based on the representative sample. RESULTS: Within the study period there were 194,553 hospitalizations due to the TBI in two DRGs. The overall incidence was 126.52/10(5)/year (95% CI = 125.96-127.09). The most common diagnosis was concussion, with an incidence of 81.66/10(5)/year, and the most prevalent structural injury was subdural haematoma (15.27/10(5)/year). The predominant external causes were traffic accidents (40.52%) followed by falls (32.77%). CONCLUSIONS: The incidence of TBIs in Poland compared with other countries in Europe is relatively low. The incidence of concussions mirrored current treatment guidelines rather than real epidemiology.

Reliability and validity of the Polish version of the Core Outcome Measures Index for the neck.

PURPOSE: Patient reported outcome measures play an increasingly important role in the outcomes research. The Core Outcome Measures Index (COMI) is a short, multidimensional instrument initially developed for the use by patients with low back pain. This study is an evaluation of a Polish version of COMI adapted for neck pain. METHODS: One hundred twenty-three patients complaining of neck pain were enrolled. All of them completed a questionnaire booklet containing COMI-neck, Neck Disability Index and Likert-type questions regarding the frequency of use of pain medications and pain frequency. Ninety-eight patients returned the retest questionnaire. Data quality was also assessed. Assessment of psychometric properties included examination of data quality, construct validity, test-retest reliability and factor analysis. RESULTS: The quality of data was good with no missing answers and a little floor effect. Exploratory factor analysis revealed a single-factor structure. Reliability expressed as intraclass correlation coefficient was 0.88 (95% CI 0.84-0.92) for the overall COMI score and was generally good for most of individual core items. The minimum detectable change (MDC95%) was 1.97. CONCLUSION: This version of the COMI-neck is a valid and reliable instrument, with good psychometric properties. It can be recommended for Polish-speaking patients.

Spine and spinal cord injuries--causes and complications.

BACKGROUND: The spine as a motor organ is very often exposed to the action of forces released by an injury. The most frequent cause of spine and spinal cord injuries are traumas which are the result of accidents, and untreated osteoporosis or neoplasms as well. OBJECTIVES: Aim of the study is an analysis of the causes of spine and spinal cord injuries as well as of the complications of these injuries. MATERIAL AND METHODS: The material covers 130 patients hospitalized due to spine injury in 2008-2010 at the Clinical Department of Neurosurgery of Wroclaw Medical University. The data has been obtained on the basis of an analysis of medical and nursing documentation. RESULTS: In the research group, men (64%) prevail over women (36% of the respondents). Most often, spine injuries affected patients aged over 60. Spine injuries without spinal cord injury comprised 84.6%, whereas with spinal cord injury only 15.4%. About 75% of the examined patients were admitted to the department as emergency admissions, within the time exceeding 12 hours since an injury occurrence (58.5%). The vast majority of patients (80%) were treated surgically. After completing treatment, most of the respondents were discharged (71.5%). After leaving the hospital, over half of the patients (52.3%) were not able to move on their own. CONCLUSIONS: The most common causes of spine injuries in patients are pathologic injuries (28.5%), traffic collisions (27.7%) and falls from heights (20.0%). To the largest degrees, spine injuries concerned the thoracic segment (in 34.6%), cervical segment (32.3%) and lumbar (23.8%). Complications occurring after spine injuries included pain of a damaged spine segment (61.1%), pain in other location (36.6%) and gastroenterological complications (17.6%). In the case of complications after spine and spinal cord injuries, gastroenterological complications predominate (in 42.9% patients) along with complications of the urinary system (38.1%) and pain of the injured spine segment (38.1%).

[Analysis of expression of estrogen (ER) and progesterone receptors (PR) in brain glial tumors and its correlation with expression of p53 protein and proliferating cell nuclear antigen (PCNA)]. / Analiza wystepowania receptorów progesteronowych (PR) i estrogenowych (ER) w glejakach mózgu i ich zaleznosc od ekspresji bialka p53 i jadrowego antygenu proliferacyjnego (PCNA).

BACKGROUND AND PURPOSE: All the types of the glial cells contain estrogen (ER) and progesterone receptors (PR) but their occurrence in glial tumors of the brain is still controversial. The aim of this research was the clinical analysis of ER and PR expression in correlation with histological malignancy and expression of p53 and PCNA. MATERIAL AND METHODS: The investigation was carried out on a group of 56 patients operated on at the Neurosurgical Department of Wroclaw Medical University. The percentage of tumors containing ER and PR was assessed and mean receptor expressions were compared. Classical histological tests, immunohistochemical tests for ER, PR, p53 and PCNA with monoclonal antibodies (DACO) were performed for every specimen of tumor tissue. RESULTS: ER occurred in 24 cases (42.9%), PR in 10 cases (17.9%). 49% of highly malignant gliomas (WHO III and IV) were ER positive, whereas 29% of tumors grade I and II were ER positive. Frequencies of PR positive tumors were similar in both groups. Mean PR expression in p53 positive group was 8% and in p53 negative group 1.5% (p=0.017). Mean ER expression in PCNA positive group was 7.4%, whereas in PCNA negative group 2.7% (p<0.01). CONCLUSIONS: Frequency of ER occurrence is higher in highly malignant tumors. ER expression is correlated with proliferative activity (PCNA). PR expression is positively correlated with intensity of mutant p53 protein.

[Analysis of PCNA, Ki67, AgNOR and p53 expression in brain glial tumors]. / Analiza ekspresji antygenów proliferacyjnych (PCNA, Ki67), regionów organizatorów jaderkowych (AgNOR) i bialka p53 w nowotworach glejowych mózgu.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate clinical usefulness of proliferating cell nuclear antigen (PCNA), Ki67 antigen, p53 protein and silver-binding nucleolar organizer regions (AgNOR) in brain glial tumors. MATERIAL AND METHODS: The investigation of PCNA, Ki67 and p53 was carried out on a group of 120 patients with glial tumors operated on at the Neurosurgical Department of Wroclaw Medical University including 63 patients operated again because of recurrence. AgNOR was evaluated on a group of 64 patients including 38 patients operated again. Classical histological tests, immunohistochemical tests for PCNA, p53 and Ki67 activity with monoclonal antibodies (DACO) and histochemical tests for AgNOR were performed on every specimen of tumor tissue. The level of 40% for PCNA, 2.75 (equal to median) for AgNOR and 5% for Ki67 and p53 was adopted as significant. RESULTS: Mean expression of PCNA of glial tumors grade I and II was 32%, grade III and IV - 44% (p<0.05). Mean expression of AgNOR was 1.88 and 3.16 (p=0.00001), respectively. Average PCNA expression in recurrent tumors to 12 months was 52.7% and for later recurrences - 35.4% (p<0.05). Average expressions of AgNOR were 3.38 and 2.68 (p<0.05), respectively. Differences of Ki67 and p53 expressions were not significant. CONCLUSIONS: PCNA and AgNOR expressions correlate with proliferative activity, growth rate and histological malignancy, reaching high values in highly malignant and early recurrent tumors. Antigens Ki67 and p53 do not seem to be predictive markers of glial tumors.

[Pseudocyst of the neck after traumatic avulsion of spinal C6-T2 nerve roots--case report]. / Rzekoma torbiel plynowa szyi po urazowym wyrwaniu korzeni rdzeniowych C6-Th2--opis przypadku.

A case is presented of an avulsion injury of the left brachial plexus in a woman who--after surgical reconstruction of the plexus--developed a liquid fistula from a giant pseudocyst localized in this area. A prolonged persistence of the pseudocyst resulted in a severe pain syndrome and symptoms of vascular disorders in the upper limb. Since results of local treatment (punctures, pressure dressings) were unsatisfactory, the authors decided to close the liquid fistula by suturing the damaged dural sac by means of laminectomy. The necessity of particular caution when operating in the area of intervertebral foramina is emphasized. The authors also point out that in case of any of cerebrospinal fluid leakage, special attention should be paid to stopping the escape of CSF.

[Brachial plexus tumors--neurosurgical treatment]. / Nowotwory splotu ramiennego--taktyka postepowania neurochirurgicznego.

Tumours of the brachial plexus according to present classification are included to soft tissue tumours. Because of rare occurrence of these tumours diagnostic and operative experience is relatively small. There is also a few number of publications regarding tumours of the brachial plexus. Therefore the aim of the study was to present our experience in the surgical treatment of tumours of the brachial plexus basing on the material of 5 cases treated in the years 1997-2001. There were 4 males and 1 female, age from 17 to 58 years old. Four patients were under 27 years old. In 3 cases tumours of the brachial plexus invaded the spinal canal through the intervertebral foramen and caused spinal cord compression (type A). In 2 cases tumours involved only plexus elements (type B). In 2 cases tumours were associated with neurofibromatosis type II. Five cases of neural sheath tumours included 2 schwannomas, 2 neurofibromas and 1 schwannoma malignum. All patients underwent surgery. In case of schwannomas and neurofibromas the surgical removal was radical without impairment of brachial plexus function. In case of a giant schwannoma malignum tumor, which caused flaccid paresis and symptoms of insufficient blood, supply with severe pain in the upper limb radical extirpation was also possible. In type A tumours in the first stage intraspinal part of the tumor was removed. Follow up observation lasted from 3 months to 4 years. The result of treatment of benign tumours was very good with complete function recovery of the upper limb, pain disappearance and no symptoms of recurrence in the long postoperative period. In case of malignant schwannoma in the early postoperative period both pain and symptoms of blood supply disturbances completely disappeared. The patient died 12 months after the operation because of tumor dissemination. Benign tumours of the brachial plexus can be effectively surgically treated using microsurgical techniques and, if necessary, nerve grafting. In case of malignant tumours many authors also recommend surgery with optimal sparing of the brachial plexus function and subsequent radio and chemotherapy. Low number A few cases in our series makes impossible to draw any epidemiological conclusions.