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.

[The significance of stereotactic biopsy in the diagnosis and treatment of central nervous system lymphomas]. / Znaczenie biopsji stereotaktycznej w rozpoznawaniu i leczeniu chloniaków osrodkowego ukladu nerwowego.

The paper presents seven cases of central nervous system lymphomas diagnosed in Department of Neurosurgery of Military Clinical Hospital in Bydgoszcz. The role of stereotactic biopsy in the management of this entity is underlined. Clinical, radiological and pathological symptoms met in PCNSL (Primary Central Nervous System Lymphoma) are briefly described.

[Pathomorphological evaluation in stereotactic brain tumor biopsy]. / Badanie patomorfologiczne w biopsji stereotaktycznej guzów mózgu.

The method is described of multistep pathomorphological examination of biopsy material obtained by stereotactic procedures from brain tumours. In the analysis of 260 biopsies the possibility was assessed of intraoperative cytological examinations confronting the results of these examinations with those of final histological and immunohistochemical investigations. Attention is called to the difficulties in the evaluation of material derived from stereotactic biopsies and to the cause of possible diagnostic errors. It is concluded that the combination of the results of cytological examination of smears and histological examination of paraffin slides makes possible establishing of full pathomorphological diagnosis with determination of tumour type and its malignancy degree in 90.7% of cases. On most cases cytological intraoperative examination had the greatest influence on therapeutic management. In the confrontation of these examinations with histological examinations a high proportion of correct cytological examinations was found (76.6%). Owing to the possibility of application of all techniques of morphological diagnosis, stereotactic biopsy is a reliable method in the diagnosis of brain tumours.

[Stereotactic biopsy of polylmorphic tumors and brain tumors invisible in CT image]. / Biopsja stereotaktyczna guzów polimorficznych i niewidocznych w CT.

The authors present the possibilities of obtaining tissue samples with stereotactic biopsy basing on three examples of intracranial polymorphic and invisible in CT tumours. CT scans of these tumours make a serious problem with proper targeting and tissue sampling from proper sites. Stereotactic serial biopsy directed by CT/MRI fusion is the best way of obtaining tissue material in order to establish correct diagnosis.

[Facial-cerebral gunshot wounds]. / Postrzaly twarzowo-mózgowe.

The current frequency increase of gunshot wounds to the head is directly proportional to the access to firearms and to amount of firearm-related crimes. This risk is increasing especially in population groups that have not been threatened before. Hence the aim of this study was to analyse and resume our experiences in the management of faciocerebral gunshots. We retrospectively reviewed a series of 9 consecutive patients who were treated in the Department of Neurosurgery, Military Clinical Hospital in Bydgoszcz with the diagnosis of gunshot wound to the head from 1994 to 1999. All the cases were young males (mean, 26 yr). There were six suicidal attempts and three accidents at firearm service. KbkAK, that is a standard machine gun in the Polish Army, was most frequently related to gunshots in the analysed series. All the patients were assessed according to Glasgow Coma Scale (GCS) at arrival to hospital. Average of admission GCS Score was 6.1. The patients were also assessed after treatment using Glasgow Outcome Scale (GOS). One patient was dead (GOS Score 1), and 7 (78%) improved to good, independent functional status (GOS Score 4 or 5). The authors emphasize the necessity of multispecialistic initial operative management of faciocerebral gunshots wounds and aggressive pre- and postoperative care (tracheostomy, gastrostomy, treatment of encephalitis), which makes it possible to obtain good and very good outcomes. Furthermore, we stress the role of minimal primary debridement for the sake of frequent secondary reconstructive operations.

[Anterior interbody fusion of cervical spine with BAK-C: case reports]. / Przednia stabilizacja miedzytrzonowa kregoslupa szyjnego nowego typu implantem typu BAK-C--prezentacja przypadków.

Two cases of cervical discopathy operated on with anterior interbody fusion with the BAK-cage are described. The authors stress the advantages of this kind of stabilization: shorter time of the operation, no bone graft complication, immediate stabilization without collar. The technical procedures of BAK-cage implantation, indications and exclusion criteria are discussed.

[The role of stereotactic biopsy in diagnosis of pineal region tumors]. / Rola biopsji stereotaktycznej w diagnostyce guzów okolicy szyszynki.

The anatomy, pathophysiology nad treatment of the pineal region tumors are presented. The authors stress the role of stereotactic biopsy in the diagnosis and correct management. Based on the literature and their experiences the risk of complications and incorrect diagnosis is discussed.

[Use of stereotactic methods in neurosurgery practice]. / Wykorzystanie metody stereotaktycznej w praktyce neurochirugicznej.

Beginnings and historical evolution of stereotaxis and its role in a contemporary neurosurgery are performed. Application of this technique in clinical practice is reviewed. Brief description of stereotactic methods in neurooncology, movements disorders surgery, chronic pain therapy, radiosurgery, modern methods of neuronavigation as well as photodynamic and gene therapy is presented.

[The use of doppler color ultrasonography in the evaluation of superior sagittal sinus patency in operations for parasagittal meningiomas]. / Zastosowanie USG colour-Doppler w ocenie droznosci zatoki strzalkowej górnej w czasie operacji oponiaków przystrzalkowych.

The authors present the possibility of replacement of invasive angiography by non-invasive, safer, more accurate USG-colour Doppler performed during the operation to estimate the permeability of superior sagittali sinus in falx meningioma cases. Based on the presented case they discuss the advantages of this method in relation to angiography routinely performed so far.

Effect of treatment with 21-aminosteroid U-74389G and glucocorticoid steroid methylprednisolone on somatosensory evoked potentials in rat spinal cord during mild compression.

The purpose of this investigation was to compare the effects of treatment with glucocorticoid steroid methylprednisolone (MP) and the 21-aminosteroid U-74389G on the conduction of somatosensory evoked potentials (SEPs) during experimental spinal cord compression. Forty-five adult male Wistar rats were anesthetized and a laminectomy performed at the Th9-Th10 level. Animals with the same SEP patterns prior to and after laminectomy were randomly allocated to one of three groups (15 rats in each). A 14.8-g weight was applied to the dural surface of the spinal cord for 60 min. The SEPs were continually recorded during compression. The rats received a single intravenous bolus dose of three different agents two minutes after the start of compression. Animals in the first group received 0.5 ml of 0.9% NaCl, the second group received 30 mg/kg methylprednisolone and the third group received 3 mg/kg U-74389G. Following drug infusion the time period required for the SEPs to be completely suppressed was assessed. If the SEPs were not fully suppressed, the amplitude of the most stable and significant component of the SEPs was measured. The time taken to complete the SEPs suppression was significantly shorter in the control group (p < 0.001, Wilcoxon) than in the groups with either MP or U-74389G. However, the time taken to achieve full suppression was not significantly different between the MP and U-74389G groups. The proportional reduction of amplitude N1P1 was significantly different between the control and MP groups as well as between the control and U-74389G groups. The proportional reduction of amplitude N1P1 was not significant between the MP and the U-74389G groups. The present data indicate that both the glucocorticoid steroid MP and the 21-aminosteroid U-74389G protect spinal cord function to a similar extent during mild compression.

[A case of cervical myelopathy treated by "open-door laminoplasty]. / Przypadek mielopatii szyjnej leczonej laminoplastyka "otwartych drzwi".

A case of cervical myelopathy is reported. In the treatment "open-door" laminoplasty was applied using titanium implants after laminoplasty for stabilization of the posterior bone block. The "open-door" laminoplasty is an easy and safe method making possible avoiding of such complications after laminectomy as instability, kyphotic deformity and development of scar compressing the spinal cord.

[Complications after surgery of the anterior cervical spine]. / Powiklania po operacjach kregoslupa szyjnego z dostepu przedniego.

Every year several thousands of operations on the cervical spine from anterior approach are performed in the world for decompression of spinal cord and nerve roots. It is estimated that in 0.2 to 12% of the operations serious intraoperative and postoperative complications occur. Such cases have been reported in the world literature but in scant numbers. The authors discuss early and late complications after operations on the cervical spine connected with the surgical method.

Electrophysiological investigations of the mild spinal cord injury in rats.

Somatosensory evoked potentials (SEPs) waveform recorded from the normal and injured spinal cord in rats were analyzed. A mild compression spinal cord injury was performed in two experimental models. The first model was used to assess the disappearance and the second one the return of the electrophysiological spinal cord function after injury. In the first experimental model typical changes in waveforms morphology from normal to isoelectric line during spinal cord compression were investigated. In the second model an isoelectric line was achieved by more severe but a shorter time of compression and the typical changes in SEPs morphology after decompression were described. Our evidence suggests that the spinal cord function disappears gradually during mild compression and can return early after decompression. The amplitude after decompression first improved and then gradually deteriorated which is probably caused by secondary insult. Experimental models are both effective and simple and may be used to evaluate the effect of treatment of spinal cord injuries.

[Multifocal astrocytoma diagnosed by peroperative ultrasound scanning]. / Wieloogniskowy gwiazdziak mózgu znaleziony przy pomocy sródoperacyjnego badania USG--opis przypadku.

A multifocal astrocytoma, an uncommon cerebral lesion is presented. This case is particularly interesting because it was diagnosed by peroperative ultrasound scan. The epidemiology and the diagnostic procedure for multifocal gliomas is discussed.

[Embolization of AVM's of thoracic spinal cord with histoacryl glue]. / Embolizacja naczyniaków odcinka piersiowego rdzenia kregowego za pomoca kleju histoakrylowego.

The authors present two cases of inoperable AVM's of thoracic spinal cord successfully treated by embolization with histoacryl glue (B. Brown Melsungen AG). The glue used for embolization is characterized by instant polymerization when comes in contact with blood. A mass of polymer is visible on X-ray thanks to contrast medium Lipiodol and metallic powder Tungsten that are added to glue and injected together with the latter. In the first case, a female who presented with paraparesis and walked only with assistance embolization performed in one session resulted in neurological improvement enabling independent walking at follow-up 2 yrs later. In the second case of a young male not walking for severe paraparesis embolization performed in three sessions resulted in significant neurological recovery. 10 days after the first session the patient became ambulatory. 6 months after treatment he presented with mild paraparesis and was still ambulatory and leading independent life. In each case embolization was performed after balloon occlusion test during which the function of spinal cord was monitored by somatosensory evoked potentials and neurological assessment.

[The physiopathology of acute spinal cord injury and a hope for a successful treatment]. / Patofizjologia urazu rdzenia kregowego i nadzieje na skuteczne leczenie.

The acute phase of spinal cord injury includes primary and secondary pathological patterns. Primary patterns include the effects of contusion, laceration, stretch of neural tissue and direct vascular trauma. These changes are irreversible. Secondary patterns include posttraumatic ischemic changes, loss of energy metabolism, oedema, release of cytotoxic substances such as free radicals, and electrolyte changes such as an increase in intracellular calcium ions. These changes may be reversible. This determines treatment strategies. Free-radical scavengers, opioid receptor antagonists include TRH and its analogues, calcium channel blockers, volume expander, osmotic diuretics, hypothermia, antioxidants, cycloxygenase inhibitors, serotonin antagonists and NMDA receptor antagonists were tested in experimental models during the last 4 years. The successful treatment should break the feedback loops and trails of secondary injury cascade in many places so combined treatment connected with many elements and surgery decompression is necessary.

[Somatosensory evoked potentials in the assessment of preserved function of long spinal cord pathways versus decisions of operation]. / Somatosensoryczne potencjaly wywolane w ocenie zachowania czynnosci dlugich dróg rdzeniowych a decyzja operacyjna.

In the light of several presented clinical cases the authors point out the usefulness of somatosensory evoked potentials for the objective determination of the continuity of long pathways in the spinal cord, which in correlation with the clinical findings and results of imaging methods helps in making the decision of surgical intervention. The non-invasiveness of this method makes possible repeated safe control examinations for assessment of the dynamic of lesions in the cord and objective assessment of the neurological condition after operations on the cord.

[A case of complete Th7-Th8 fracture-dislocation treated by one-stage posterior and transthoracic approach]. / Przypadek calkowitego podwichniecia Th7-Th8 bez uszkodzenia rdzenia kregowego operowany z jednoczasowego dojscia tylnego i przez klatke piersiowa.

The authors present a case of severe traumatic fracture-dislocation of Th8 with total anterior slippage of Th7 on Th8 without spinal cord injury. The patient underwent one-stage anterior and posterior decompression. Posterior surgery included Th4 to Th9 laminectomy and Th7-Th8 facetectomy and posterior bone graft. Anterior procedure included Th8 vertebrectomy, anterior interbody bone graft and anterior plating with usage of "Zespol" plate and screws anchored in Th6, Th7, Th8 and Th9 vertebral bodies. Postoperative period was uneventful and the patient remained neurologically intact. He was placed in a plaster jacket and mobilized of fifth day after surgery.

[Thoracic outlet syndrome: results of surgical treatment]. / Zespól górnego otworu klatki piersiowej--wyniki leczenia chirurgicznego.

21 patients with thoracic outlet syndrome (t.o.s.) were operated on in the Department of Neurosurgery of MMA in Lódz between 1982-1991. Early and long-term results of treatment were analyzed in the group of 13 cases. In early postoperative period 5 patients were free of pain and neurologic or vascular disturbances in the upper limb. In other 6 cases pain disappeared partially and mild neurological or vascular syndromes persisted. Altogether satisfactory results of treatment were obtained in 8 patients (85%). There was some improvement in 2 patients but pain and neurological or vascular disorders were still significant after surgery. Long-term results were assessed at least 1 year after operative treatment. Recurrent pain with or without mild neurological (vascular) syndromes appeared in 6 patients (46%). Recurrent t.o.s. occurred mainly in cases of young women with low position of shoulder girdle and poorly developed musculature of this region. Only 2 patients still remained free of preoperative syndromes. Altogether only 8 patients (61%) had acceptable results of surgical treatment at long-term follow-up. The remaining 5 patients (39%) had unsatisfactory long-term results.