[Analysis of the results of combined treatment of poorly differentiated brain gliomas]. / Ocena wyników skojarzonego leczenia niskozróznicowanych glejaków mózgu.

In a group of 139 patients with poorly differentiated brain gliomas controlled clinical trial was carried out for assessment of two methods of postoperative treatment. After possibly radical removal of the glioma the patients were treated by radiotherapy with 60Co teletherapy in doses of 60 Gy (30 fr) in depth during 6 weeks, and randomly chosen patients received also CCNU in one dose of 100 mg/m repeated at intervals of 6-8 weeks. The administration of CCNU failed to improve the therapeutic results. The median survival time in the whole group was 49 weeks. The survival rate after 1, 2 and 3 years was 45.4%, 22.8% and 14.9% respectively. The survival times of cases of glioblastoma multiforme were not significantly different from those of patients with other poorly differentiated gliomas independently of the treatment method. The complications were not troublesome.

[Relation between cerebral blood flow and the changes in perfusion pressure in patients with brain compression processes]. / Zaleznosc przeplywu mózgowego krwi od zmian cisnienia perfuzyjnego u chorych ze sprawami uciskowymi mózgu.

In 20 patients with expanding intracranial lesions the cerebral blood flow was determined by the method of Kety-Schmidt in an own modification with an original device--N2O-meter, with simultaneous continuous measurement of the intraventricular pressure and arterial blood pressure. This made possible determination of the cerebral perfusion pressure and of the effect of its fluctuations on the cerebral blood flow. Lowering of the cerebral blood flow below the normal value occurred when the perfusion pressure fell below 60 mm Hg, but its further fall, even to 20 mm Hg, caused no proportional decrease of the cerebral blood flow.

[Neuropsychological evaluation of the results of treatment of hydrocephalus using a ventriculo-atrial valve]. / Neuropsychologiczna ocena wyników leczenia wodoglowia zastawka komorowo-przedsionkowa.

In 25 patients with hydrocephalus of various grades and aetiology treated by insertion of ventriculoatrial valves neuropsychological investigations were carried out before and after this operation using the method of Luria and certain psychometric tests. The obtained results made possible isolation of three grades of impairment of higher nervous functions: III--afunction--10 patients, II--dysfunction--12 patients, I--eufunction--3 patients. Control neuropsychological examination two weeks after the operation demonstrated improvement of higher nervous functions in 6 cases with grade III and 11 patients with grade II impairment. In these cases radiological investigations demonstrated evidence of normotensive and hypertensive hydrocephalus and this was confirmed by measurements of intraventricular pressure of the cerebrospinal fluid. In 5 cases with grades III and II of damage no improvement was found. Radiograms and measurements of intraventricular pressure suggested in these cases hydrocephalus due to brain atrophy.

[Experience of the Lublic center with the combined treatment of supratentorial glial brain tumors. Preliminary report]. / Doswiadczenia osrodka lubelskiego w skojarzonym leczeniu nadnamiotowych glejopochodnych nowotworów mózgu. Doniesienie wstepne.

The results of combined treatment were analysed in 38 cases of cerebral gliomas. In the group of 14 patients with glioblastoma multiforme treated surgically and by later radiotherapy and chemotherapy by the schedule of Hildebrand a mean arrival time of 116 weeks was obtained and the one-year survival rate was 71%. In the group of inoperable gliomas (16 cases) treated by radiotherapy and chemotherapy the mean survival time was 47 weeks and the one-year survival rate was 44%.

[Nocturnal sleep patterns during treatment of hydrocephalus]. / Zachowanie sie snu nocnego w czasie leczenia wodoglowia.

By polygraphic methods the authors studied the sleep patterns during treatment of patients with subtentorial tumours causing hydrocephalus. Sleep recording was carried out in three stages of treatment: 1) before insertion of ventriculo-atrial valve, (7 investigations), 2) on the 7th day after valve insertion (7 investigations), 3) two months after removal of the posterior fossa tumour (3 investigations). The control group included patients with peripheral nerve injury in whom sleep recording was done before and after surgical treatment. In cases with hydrocephalus and raised CSF pressure before valve insertion the cyclic pattern of sleep was disintegrated, showing long periods of light sleep (phase 1 + 2) interrupted by long periods of alertness, during sleep, mostly with elimination of the remaining sleep components. The decrease of CSF pressure after valve implantation was parallelled by partial normalization of sleep pattern, that is shortening of the light sleep phase and reduction of the number of alertness during sleeping hours, as well as prolongation of the phases of deep sleep and appearance of paradoxical sleep. However, only removal of the tumour from the posterior fossa made possible approximation of sleep elements to those in the control group. Sleep disintegration of varying intensity in patients with hydrocephalus may be reversible, the rate of normalization of sleep depends on the intensity of sleep disturbances in the initial stage of the disease, but return to nearly normal sleep is possible only after removal of the subtentorial tumour.

[Clinico-theoretical aspects of cerebrospinal fluid pressure changes associated with sleep analysis in patients with hydrocephalus caused by posterior fossa tumors]. / Aspekty kliniczno-poznawcze zmian cisnienia plynu mózgowo-rdzeniowego w polaczeniu z badaniami snu u chorych z wodoglowiem spowodowanym guzami tylnej jamy czaszkowej.

In 6 patients treated for hydrocephalus caused by posterior fossa tumours simultaneous continuous measurement of intraventricular cerebrospinal fluid pressure and all-night polygraphic sleep recording were carried out before and after implantation of ventriculoatrial valve. It was observed that in patients with hydrocephalus and raised CSF pressure electrography demonstrated a breakdown of the cyclic sleep pattern with increased duration of light sleep and higher number of awakening episodes, and with reduced amount of deep sleep and nearly complete absence of REM sleep. The degree of sleep disturbances seemed to be correlated with increased value of CSF pressure. In that period discrepancies were observed between the sleep record suggesting waking and the behaviour of the patient who was asleep at that time. With normalization of CSF pressure record (after valve implantation) an improvement of sleep pattern was observed which approached the normal one.

[Surgical treatment results in intracranial aneurysms]. / Wyniki leczenia operacyjnego tetniaków wewnatrzczaskowych.

Therapeutic results are reported in 115 patients operated upon for intracranial aneurysms using the microsurgical technique from Yasargil's approach. Elimination of the aneurysm from the circulation by clipping its pedicle was done in 94 cases (82%), trapping of the afferent artery (12%), in 7 cases (6%) only the wall of the aneurysmatic sac was strengthened by wrapping. A good therapeutic result was obtained in 68 patients (59.1%), satisfactory in 6 (5.2%), poor in 13 (11.3%). The overall mortality was 24.4% (28 cases) but after taking into account 4 patients dying due to extracerebral causes, the mortality caused by complications related to exclusion of the aneurysm from cerebral circulation was 20%. The factors influencing the results of surgical treatment of cerebral aneurysms are discussed in the light of the own material.

[Multiple intracranial aneurysms]. / Mnogie tetniaki wewnatrzczaszkowe.

Thirteen patients treated surgically for multiple intracranial aneurysms are described. They accounted for 12% of all patients with intracranial aneurysms diagnosed by arteriography. The incidence of multiple intracranial aneurysms, their location, surgical tactics and results of surgical intervention are discussed in the light of an analysis of own results and a survey of the pertinent literature.

[Studies on the cerebrospinal fluid pressure changes in patients treated for hydrocephalus by the so-called ventricular filling test. Preliminary report]. / Badania nad zmianami cisneinia plynu mozgowordzeniowego (CPMR) u chorych leczonych z powodu wodoglowia, przy zastosowaniu tzw próby dopelniania ukladu komorowego.

The curves of cerebrospinal fluid pressure (CFP) in the lateral cerebral ventricle during the so called ventricular filling-up test are presented in 6 patients with high-pressure and medium-pressure hydrocephalus as compared with CFP curves obtained in 2 patients with low-pressure hydrocephalus. The method of filling-up test (infusion test) is described. In this method portions of normal saline 2 ml each are administered rapidly into a lateral ventricle every 30 seconds. The obtained results demonstrated a difference in the shape of the CFP curves in patients with low-pressure open hydrocephalus as compared with patients with closed hydrocephalus. This could help in qualifying patients with hydrocephalus for treatment with ventriculo-atrial shunt.

[Results of surgical treatment of aneurysms of the anterior communicating artery]. / Wyniki leczenia operacyjnego tetniaków tetnicy laczacej przedniej.

The authors present the results of surgical treatment of 48 aneurysms situated on the anterior communicating artery operated upon by the classic and microsurgical methods. The latter method has made it possible to raise the proportion of very good and good results from 23% in the classic method to 70%, and to reduce the postoperative mortality in groups I and II of condition severity from 13.6% to 4%. Independently of the method used Korsakoff's syndrome was observed in 17% of cases. The high value of Yasargil's surgical approach is stressed.

[Chronic bilateral subdural hematoma]. / Przewlekle dwustronne krwiaki podtwardówkowe.

The authors report 31 patients treated surgically for chronic bilateral subdural haematomas stressing the diagnostic difficulties in such cases and discussing the value of radiological investigations and surgical methods, especially multipoint trepanation.

[Results of surgical treatment of post-traumatic intracerebral hematoma]. / Wyniki leczenia operacyjnego pourazowych krwiaków sródmózgowych.

The authors discuss the results of surgical treatment of traumatic intracerebral haematomas on the basis of own material of 44 cases and a survey of literature. The rarity of this complication of injuries and the diagnostic difficulties are stressed, the usefulness of surgical approach is analysed and the prognostic importance of such factors as the clinical course of haematoma, severity of the patient's condition, and coexistence of other intracranial injuries is discussed.

[Epidural abscesses of the spinal cord treated surgically]. / Ropniaki nadtwardówkowe kanalu kregowego leczone operacyjnie.

The authors discuss 5 cases of epidural empyemas of the vertebral canal in which a good surgical effect was obtained. On the basis of a literature survey and own material they discuss the aetiology of the disease, its rarity, and diagnostic difficulties caused frequently by absence of typical neurological changes, lack of systemic inflammatory reaction and primary purulent focus.

[Results of surgical treatment of intracranial epidural hematoma]. / Wyniki leczenia operacyjnego wewnatrzczaszkowych krwiaków nadtwardówkowych.

The authors discuss the results of surgical treatment of intracranial epidural haematomas in the light of own material of 84 cases. In relation to reports in the literature the authors call attention to diagnostic difficulties in atypical cases and discuss the importance of signs of prognostic value for the life of the patient and factors increasing mortality. The signs of poor prognosis include: respiratory disturbances, bilateral pupillary dilatation, coma with disturbances of basic vital functions and decerebrate rigidity. The mortality is increased by co-existent intracranial injuries, especially brain lacerations. The prognosis was best in cases operated upon during the lucid interval. Very good and good results of treatment were achieved in 86% of cases, satisfactory in 8%, with a general mortality of 26%, which was highest in the group with acute haematomas reaching 43%.

[Results of polygraphic nocturnal sleep recording in patients with supratentorial brain tumors prior to and following surgery]. / Ocena wyników badania poligraficznego snu nocnego u chorych z guzami nadnamiotowymi mózgu w okresie przed i pooperacyjnym.

The purpose of the study was to establish the influence exerted by a supratentorial brain tumour on the EEG correlates of sleep, and to compare the results before and after operation. Five patients were studied (aged 38 to 59 years) who were treated surgically for supratentorial expanding lesions: two cases of meningioma (in left parietal area), two cases of glioma (right parietal area and occipital area) and one case of intracerebral haematoma. The control group comprised 5 patients operated upon for lesions of the peripheral nerves of extremities. In the patients with supratentorial brain tumours and after their removal the following sleep parameters were unchanged: total sleep duration, number of awakening during sleep, latency time of the first REM phase and stage 3 NREM (deep and superficial sleep). The amount of REM sleep increased after tumour removal. REM-sleep density was selectively and permanently disturbed. In presence of tumour REM-sleep density was found in traces only, after tumour removal it increased but showed a permanent high-grade deficit in relation to controls.

[Radical and conservative methods in the surgical treatment of brain abscesses]. / Radykalne i oszczedzajace metody leczenia operacyjnego ropni mózgu.

In the light of own experience with 50 patients with brain abscesses and a survey of the literature the authors discuss the values of the surgical methods of treatment in this disease. When the radical methods are used the mortality is lowest and the incidence of recurrent abscesses is lowest, but of this treatment is likely to produce considerable neurological deficit it is better to apply conservative methods, such as puncture and drainage of the abscess. The sparing operation as a method of choice may be the first stage of treatment before radical operation in acute abscess and in patients in serious clinical condition.

[Surgical treatment of aneurysms of the anterior communicating artery using Yasargil's approach]. / Leczenie operacyjne tetniaków tetnicy laczacej przedniej mózgu z dojscia sposobem Yasargila.

The results of surgical treatment in 19 cases of aneurysms of the anterior communicating artery from the approach described by Yasargil are described. In 16 patients the pedicle of the aneurysm was closed with a clip, in 2 cases the anterior communicating artery was excluded from the circulation by trapping, and in only 1 patient the aneurysm was enclosed in muscle and gazue. Control angiography demonstrated in 16 cases exclusion of the aneurysm from the circulation with maintenance of the patency of the main vessels, and in one case the sac of the aneurysm was partly shadowed. Good results were obtained in 80% of cases. One patient died (5%). Complications with development of Korsakoff's syndrome were observed in 3 patients (15%). The advantages of the approach described by Yasargil for the exposure and safe management of anterior communicating artery aneurysms are stressed.