Corrigendum for: Evaluation of Blood-Brain Barrier Integrity by the Analysis of Dynamic Contrast-Enhanced MRI - a Comparison of Quantitative and Semi-Quantitative Methods.

List of changes: On the basis of author's request the publisher of Physiological Research decided to change the license of the article to CC BY license.

[Femoral Fractures in Children Younger than Two Years. Are We Considering Abusive Etiology?] / Fraktury femuru u detí do dvou let. Pomýslíme na moznost týrání?

PURPOSE OF THE STUDY: The primary aim is to assess the proportion of children younger than two years with a femoral fracture who underwent a skeletal survey. The secondary aim of the study is to evaluate the patients' demographics, reported trauma mechanism, type of fracture, type of treatment and complication rate. MATERIAL AND METHODS This was a retrospective study of children younger than two years examined at the Department of Imaging Methods for a femoral fracture between 2015-2022. The type and site of the fracture were assessed on radiographs. The patients' medical records were used to assess which steps had been taken to evaluate for possible abusive etiology of the fracture. The data were correlated with the published guidelines for performing skeletal survey in young children with fractures. The patients' demographics, medical history, time interval from trauma or symptoms onset to medical examination, type of treatment, duration of orthopaedic follow-up in addition to the clinical fi ndings at the last orthopaedic follow-up visit were also retrieved from the patients' medical records. RESULTS A total of 40 children were included in the study, 21 of whom were girls (52.5%). The mean age was 13.8 months. 5 children (12.5 %) were younger than 6 months. 36 children (90%) had a history of trauma, the vast majority of whom suffered a fall. 21 patients (52.5%) sustained a distal metaphyseal fracture, 19 patients (47.5%) suffered a diaphyseal fracture. A spica cast was used in 12 patients (30%), which was applied under general anaesthesia in most cases. 28 patients (70%) received a long leg cast. A certain degree of stiffness following cast removal was the only documented complication. Based on the published guidelines, it was estimated that in 23 patients (57.5%) a skeletal survey should have been performed. However, this investigation was performed in 2 patients (5%) of the study population only. DISCUSSION Femoral fractures in young children are rare, especially in those younger than six months of age. The fractures were located in femoral diaphysis and in distal femoral metaphysis. Surgical treatment was not required, and no signifi cant complications were observed. Nonetheless, the study showed that the rate of child abuse screening was low. The skeletal survey was performed in two cases only, both children were younger than six months and had no history of trauma. Based on the published guidelines, however, it may be assumed that the skeletal survey should have been performed in more than half of the patients in the study. The failure to perform this investigation might have led to the abuse not being detected and the child being returned to the abusive environment. CONCLUSIONS Management of femoral fractures in patients younger than two years does not usually require hospitalisation and is not associated with the risk of complications. However, potential further harm may be caused if abusive etiology of the femoral fracture fails to be discovered. This study has shown that the rate of abuse evaluation is low. It is essential to initiate a multidisciplinary discussion on this topic to raise the physicians' awareness and to implement the screening for child abuse among young children with femoral fractures. This scientifi c paper also includes a summary of necessary steps to be taken in the evaluation of a young child with a femoral fracture. KEY WORDS: fractures, femur, children, infant, child abuse, radiography.

Magnetic resonance imaging techniques for indirect assessment of myelin content in the brain using standard T1w and T2w MRI sequences and postprocessing analysis.

Magnetic Resonance Imaging (MRI) has revolutionized our ability to non-invasively study the brain's structural and functional properties. However, detecting myelin, a crucial component of white matter, remains challenging due to its indirect visibility on conventional MRI scans. Myelin plays a vital role in neural signal transmission and is associated with various neurological conditions. Understanding myelin distribution and content is crucial for insights into brain development, aging, and neurological disorders. Although specialized MRI sequences can estimate myelin content, these are time-consuming. Also, many patients sent to specialized neurological centers have an MRI of the brain already scanned. In this study, we focused on techniques utilizing standard MRI T1-weighted (T1w) and T2 weighted (T2w) sequences commonly used in brain imaging protocols. We evaluated the applicability of the T1w/T2w ratio in assessing myelin content by comparing it to quantitative T1 mapping (qT1). Our study included 1 healthy adult control and 7 neurologic patients (comprising both pediatric and adult populations) with epilepsy originating from focal epileptogenic lesions visible on MRI structural scans. Following image acquisition on a 3T Siemens Vida scanner, datasets were co registered, and segmented into anatomical regions using the Fastsurfer toolbox, and T1w/T2w ratio maps were calculated in Matlab software. We further assessed interhemispheric differences in volumes of individual structures, their signal intensity, and the correlation of the T1w/T2w ratio to qT1. Our data demonstrate that in situations where a dedicated myelin-sensing sequence such as qT1 is not available, the T1w/T2w ratio provides significantly better information than T1w alone. By providing indirect information about myelin content, this technique offers a valuable tool for understanding the neurobiology of myelin-related conditions using basic brain scans.

CT findings predicting lung resection in children with complicated community-acquired pneumonia.

PURPOSE: To investigate computed tomography (CT) features which predict lung resection in children with complicated community-acquired pneumonia. METHODS: A retrospective study of CT findings of patients with complicated pneumonia treated between January 2010 and December 2019. Fisher's exact test and ROC curves were used for statistical analysis. RESULTS: The study cohort consisted of 84 patients who underwent chest CT for complicated pneumonia. Lung resection was performed in 36 patients, 3 patients were treated by lung decortication, 45 patients were cured conservatively. Seven CT features were found statistically significant among the patients who underwent lung resection. 80.5% of patients from the resection group had two or more of these features on the initial CT scan, 64% had three or more. According to ROC analysis, simultaneous occurrence of multiple cavities equal to or greater than 3 cm and lung abscess predicted a pulmonary resection. CONCLUSION: The combination of CT features which clearly predict lung resection are the simultaneous occurrence of multiple cavities ≥ 3 cm and lung abscess. The most common triple combination of CT signs in the resected group of patients were multiple cavities ≥ 3 cm, consolidation of lung tissue and pleural effusion < 3 cm.

Evaluation of blood-brain barrier integrity by the analysis of dynamic contrast-enhanced MRI - a comparison of quantitative and semi-quantitative methods.

Disruption of the blood-brain barrier (BBB) is a key feature of various brain disorders. To assess its integrity a parametrization of dynamic magnetic resonance imaging (DCE MRI) with a contrast agent (CA) is broadly used. Parametrization can be done quantitatively or semi-quantitatively. Quantitative methods directly describe BBB permeability but exhibit several drawbacks such as high computation demands, reproducibility issues, or low robustness. Semi-quantitative methods are fast to compute, simply mathematically described, and robust, however, they do not describe the status of BBB directly but only as a variation of CA concentration in measured tissue. Our goal was to elucidate differences between five semi-quantitative parameters: maximal intensity (Imax), normalized permeability index (NPI), and difference in DCE values between three timepoints: baseline, 5 min, and 15 min (delta5-0, delta15-0, delta15-5) and two quantitative parameters: transfer constant (Ktrans) and an extravascular fraction (Ve). For the purpose of comparison, we analyzed DCE data of four patients 12-15 days after the stroke with visible CA enhancement. Calculated parameters showed abnormalities spatially corresponding with the ischemic lesion, however, findings in individual parameters morphometrically differed. Ktrans and Ve were highly correlated. Delta5-0 and delta15-0 were prominent in regions with rapid CA enhancement and highly correlated with Ktrans. Abnormalities in delta15-5 and NPI were more homogenous with less variable values, smoother borders, and less detail than Ktrans. Moreover, only delta15-5 and NPI were able to distinguish vessels from extravascular space. Our comparison provides important knowledge for understanding and interpreting parameters derived from DCE MRI by both quantitative and semi-quantitative methods.

OPTIC CHIASM WIDTH IN NORMAL-TENSION AND HIGH-TENSION GLAUCOMA.

PURPOSE: The aim of our study was to find out whether in patients with hypertensive glaucoma (HTG) and normotensive glaucoma (NTG), there is a change in the size of the chiasm depending on the changes in the visual field. Therefore, we retrospectively measured the width of the chiasm in the patients to whom we measured the size of the corpus geniculatum laterale in 2013. MATERIALS AND METHODS: The group consisted of two groups of patients. Nine with hypertensive glaucoma (HTG) and nine with normotensive glaucoma (NTG). The diagnosis was based on a complex ophthalmological examination and in NTG and electrophysiological examination. The visual field was examined by a rapid threshold program on the Medmont M700. The sum of the sensitivity from both visual fields in the range of 0-22 degrees was compared with the width of the chiasm obtained by the magnetic resonance imaging using the eight channel head coil. The measured values of all subjects were analyzed using a paired t-test and a correlation coefficient. RESULTS: We found a reduction in the chiasma width in both glaucoma groups. We found a statistically significant difference in the size of the chiasm (p = 0.0003) between the control group and the HTG group (p = 0.001). The narrowing of the chiasm showed a slight correlation in HTG with changes in the field of vision (r = 0.139) and in NTG a moderate correlation (r = 0.375). CONCLUSION: We found a reduction in the size of the chiasm in both HTG and NTG. The sum of sensitivities in the central parts of the visual field, however, more correlated with the reduction in the size of the chiasm in NTG. This finding shows that there are two different diagnostic groups.

Torcular dural sinus malformations: a grading system proposal.

BACKGROUND: Torcular dural sinus malformations (tDSMs) are congenital complex vascular anomalies often referred as a single unit. Nevertheless, they possess distinct anatomical features, clinical diversity, and markedly different outcomes. OBJECTIVE: On the basis of our institutional experience and analysis of published data, we propose a grading system. METHODS: We have identified 44 papers to which we added our four institutional cases for a total of 126 patients. Eight predictor variables were studied. In order to assess their individual impact on mortality and possible correlations, a logistic regression model was constructed through a stepwise forward process. RESULTS: Overall mortality was 22.1%. Mortality was higher in tDSM patients diagnosed postnatally, 40.7% versus a 15.6% in prenatally found cases (p = 0.007). We divided the patients into four grades. Grade I comprised patients with no feeder evidence and possessed the best outcomes (mortality of 7.55%). Mortality rose for grades II and III defined respectively by scarce and multiple feeders. Brain damage was the defining feature of grade IV. A mortality of 75% could be observed within this grade. Grade IV was further divided into grades IVa (antenatal) and IVb (postnatal cases). Furthermore, our logistic regression model found that brain damage (OR 11.3, p < 0.001, 95% CI 2.97-42.91) and patent feeders (OR 4, p = 0.03, 95% CI 1.15-13.86) were major determinants of poor outcome (area under ROC curve of 81.44%). CONCLUSION: The grading system (tDSM-GS) streamlines classification into four different grades facilitating both diagnosis, clinical decision-making, and proper prognostication.

Late Functional and Morphological Findings after Methylalcohol Poisoning.

AIM: The aim of the study was to determine the morphological and functional findings in a patient after methanol poisoning. Examination methods: The patient (male, 38 years old) was suffered methanol poisoning in eight years ago (2012). The following tests and examinations were performed: neurological visual field XR test (Medmont M700), retinal nerve fibre layer (RNFL), ganglion cell complex (GCC) and peripapillary vessel density (all using Avanti RTvue, Optovue), pattern electroretinography (PERG) and pattern visual evoked potential (PVEP) examination according to ISCEV methodology (Roland Consult Instrument) and brain MRI examination (Philips Achieva Dstream 3 T). RESULTS: The biggest changes were found in RNFL and VD. PERG also showed damage to retinal ganglion cell axons. In left eye we determined decrease in oscillations (in comparison with contralateral eye) at N35-P50 and P50-N95. VEPs in both eyes were significantly reduced, almost inconspicuous in the left eye. Extension of latency time of P100 was not identified. Functional MRI showed a bilateral decrease in voxel activity with a greater decrease in the left eye. There were postmalatical changes in the dorsal parts of the putamen on MRI. The width of the optic nerve and chiasm was physiological. CONCLUSION: Asymmetric damaging of RNFL and cortical centres of the brain were determined. We registered large pathological changes in VD, which are probably responsible for the deepening of optic nerve excavation and further loss of nerve fibers of retinal ganglion cells, which have not yet been described in the literature. Following these results is possible to define direct damage of nerve structures and blood vessels by toxins of methanol metabolism in the acute stage and upcoming reparation processes in following periods.

Torcular dural sinus malformations: a single-center case series and a review of literature.

INTRODUCTION: Torcular dural sinus malformations (tDSMs) are rare vascular pathologies with various anatomoclinical pictures and prognosis. We analyzed our case series and corroborated the complexity of this rare unit by a review of literature. CASE SERIES: From 2003 to 2018, we treated four tDSMs patients. The evolution of three postnatally diagnosed cases of similar angioarchitecture contrasted with a fourth antenatally diagnosed case with significant torcular thrombosis. All patients were examined by computed tomography, magnetic resonance imaging, CT angiography, and MRI angiography. Three patients underwent digital subtraction angiography with embolization of feeders. Unusual pathological images were depicted. CONCLUSIONS: Early diagnosis along with embolization of feeders and lake could improve the outcome for tDSM patients with dural arteriovenous shunts. Ventriculoperitoneal shunt implantation before endovascular treatment led to significant worsening of both clinical presentation and MRI picture. For patients who persist with hydrocephalus despite the endovascular approach, we suggest endoscopic third ventriculostomy as a first-line treatment option. Antenatally diagnosed patients with thrombosed lakes constitute a prognostically better group of patients. Spontaneous thrombosis and remodelation of the lake can, however, still leave neurological sequelae, as observed in our patient.

Electromagnetic navigation-guided neuroendoscopic transfrontal transaqueductal fenestration of expansive posterior fossa arachnoid cyst with simultaneous endoscopic third ventriculostomy in an infant.

INTRODUCTION: We present an infant with an expansive posterior fossa arachnoid cyst and severe clinical deterioration due to decompensated obstructive hydrocephalus. Given the dilated Sylvius aqueduct, we favoured the endoscopic transfrontal transaqueductal route to approach the cyst. CASE REPORT: A 12-month-old boy was acutely admitted for severe symptoms of intracranial hypertension. Imaging revealed spacious cystic formation in the posterior fossa with expansive behaviour towards the brain stem, fourth ventricle and cerebellum associated with obstructive triventricular hydrocephalus. The patient underwent electromagnetically navigated transfrontal transaqueductal cyst fenestration with simultaneous ETV from two precoronal trajectories with a rigid endoscope. CONCLUSION: A transaqueductal approach with a rigid endoscope is rarely published, and we were amazed by the impact on the child's clinical improvement after this minimally invasive endoscopic procedure. The case is well documented with imaging and perioperative neuroendoscopic views.

[Multidisciplinary approach to surgical disorders of the pancreas in children]. / Multidisciplinární prístup k chirurgickému onemocnení pankreatu v detském veku.

INTRODUCTION: Surgical diseases of the pancreas in children are not common and may be associated with significant morbidity and potential mortality. A multidisciplinary approach is essential for correct diagnosis, surgical strategy and postoperative as well as follow-up care. METHOD: Retrospective analysis of patients operated on due to a pathological lesion of the pancreas focused on diagnostics, operating procedures, postoperative complications, and long-term results. Between 1991 and 2016, eighty-nine children were treated in our department for a pathologic lesion of the pancreas. 39 of them were boys and 50 were girls. RESULTS: Mean age of the patients was 9.3 years (1 month-18.4 years). Patients were followed from the operation to the age of 19, after which they were referred for follow-up to adult specialists. The indications for surgery were trauma in 34 children, solid pseudopapillary tumor in 23 children, biopsy in 10, hyperinsulinism in 8, chronic pancreatitis in 4, pancreatic cyst in 3, insulinoma in 3, carcinoma in 2, and serous cystadenoma and pancreas divisum in one patient. The most frequent procedures performed on the pancreas were distal pancreatectomy in 35 cases, the duodenum-preserving pancreatic head resection in 23 cases, pseudocystogastroanastomosis in 11 cases, 9095% pancreatic resection in 5 cases, Whipple operation in two cases, Puestow procedure in one case, tumor enucleation in one case, and tumor biopsy for cancer in one case. In 5 patients after major pancreatic injury, ERCP and papillotomy with insertion of a stent into the pancreatic duct was performed. 3 patients died, one after a polytrauma with severe pancreatic injury and two patients with pancreatic cancer. CONCLUSION: Pancreatic surgery in children is not a common operation, and individual as well as institutional experience remains limited. After more than 20 years of experience with pancreatic surgery, we believe that close cooperation with surgeons, pediatric gastroenterologists, radiologists, anesthesiologists, intensivist, pathologists and ERCP specialists is necessary for successful diagnosis and treatment of pancreatic disease in children.Key words: pancreas pancreatic surgery in children duodenum preserving head resection of the pancreas.

[Hirschsprungs disease in adults two case reports and review of the literature]. / Hirschsprungova choroba v dospelém veku dve kazuistiky a prehled literatury.

Hirschsprungs disease (HD) in adults is extremely rare, only three publications in Czech and Czechoslovak journals making reference to the condition after childhood. We present two cases of adult patients with HD. The first case is a 46-year-old male patient suffering from chronic constipation since childhood and diagnosed with megacolon at the age of 16; however, no further detailed diagnosis was done. At the age of 41, he developed a sigmoid perforation due to fecaloma and underwent urgent rectosigmoid resection and colostomy. 5 months later, Swensons coloanal anastomosis with diverting ileostomy was performed. Postoperative course was uneventful. He has two bowel movements a day. 7 years after the Swensons procedure, he also underwent adhesiolysis for acute bowel obstruction. His daughter was operated on due to HD at 16 days of age. The second case is a 57-year-old male patient. He suffered from chronic constipation and megacolon since 2 years of age and was diagnosed with congenital megacolon at the age of 19. However, no detailed diagnostics followed. He had a long interval between stools of up to 14 days. He underwent colonoscopy and, with a diagnosis of resistant Crohns disease, was referred to a surgical department where he was diagnosed with HD. Left hemicolectomy was first performed, followed by Swensons procedure with diverting ileostomy. All postoperative courses were uneventful. Currently he passes one or two soft stools a day. Adult HD is extremely rare. However, adult surgeons should consider it in case of refractory constipation since childhood associated with megacolon. Diagnosis is based on contrast radiography and rectal biopsy. Both Swensons and Duhamels procedures are suitable for surgical management. Left hemicolectomy with colonic rotation and coloanal anastomosis and/or proctocolectomy with J-pouch anastomosis are indicated in advanced forms of non-functional megacolon.Key words: adult Hirschsprungs disease - megacolon surgical therapy.

Electromagnetic navigation-guided neuroendoscopic removal of radiation-induced intraforniceal cavernoma as a late complication of medulloblastoma treatment.

INTRODUCTION: Medulloblastoma is the most frequent malignant brain tumour in children. Radiation-induced cavernous haemangiomas (RICHs) are a known late complication of radiation exposure, especially in young children. CASE REPORT: We present a patient who underwent subtotal resection of posterior fossa medulloblastoma with subsequent chemotherapy and radiotherapy at the age of 10 years. A new lesion in the region of the left foramen of Monro appeared 16 years later. Based on the imaging results, metastasis or radiation-induced cavernoma was considered. The lesion had the same appearance on imaging as a rarely published intraventricular cavernoma of the foramen of Monro. Unlike the cavernoma of the foramen of Monro, this lesion was subependymal and intraforniceal. Using electromagnetic navigation and neuroendoscopy, the lesion was completely removed. Histopathological examination revealed a cavernous haemangioma. CONCLUSION: This is a unique case of intraforniceal paraforaminal cavernoma that was successfully removed endoscopically using electromagnetic neuronavigation and without neurological sequelae.

[Chest injuries in polytraumatized children]. / Poranení hrudníku u detí s polytraumatem.

Chest injuries in children are part of polytrauma resulting from high-energy violence, most often caused by traffic accidents. Blunt chest injuries (95%) are significantly more frequent than penetrating injuries (5%). Lung contusion, rib fracture, pneumothorax or haemothorax, are the more common injuries, but tracheobronchial rupture, cardiac or diaphragmatic injuries may also occur. The anterior X-ray image remains the basic examination method for isolated chest injuries. CT trauma scan with a contrast medium is done in polytraumatized children. Blunt injuries of intra-thoracic organs in haemodynamically stable children are treated mostly conservatively (85%) under full monitoring at the ICU. Surgical treatment is necessary in a minority of patients. Mortality and morbidity of patients with chest injury depend on the actual combination of multiple body systems injury. The severity of total injury can be predicted using objective scoring systems (Abbreviated Injury Scale=AIS; Injury Severity Score=ISS). Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to associated head injuries.Key words: multiple trauma thoracic trauma - paediatric lung contusion Injury Severity Score=ISS.

An olfactory groove schwannoma with a pseudocyst compressing the basal ganglia, internal capsule and optic tracts.

INTRODUCTION: Olfactory groove schwannomas (OGSs) are extremely rare tumours, particularly in the paediatric population. CASE REPORT: A 13-year-old girl presented with two epileptic seizures, papilloedema and incomplete binasal quadrantanopia. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a large heterogeneously enhancing tumour of the anterior skull base with a prominent dorsal pseudocyst. Interestingly, the pseudocyst embraced the right ICA bifurcation and displaced the optic tracts, optic chiasm and optic nerves and the ipsilateral basal ganglia. The patient underwent surgery via the frontolateral approach, and the tumour was completely removed. The pseudocyst was opened, and its wall was partially resected. It subsequently resolved completely. Histopathological examination yielded the rare diagnosis of schwannoma of the anterior skull base. CONCLUSION: Although extremely rare, olfactory groove schwannomas can be seen in paediatric patients. Our patient is the youngest ever reported with this histopathological diagnosis along with the formation of a large pseudocyst.

[Hepatoblastoma, Etiology, Case Reports]. / Hepatoblastom, etiologie, kazuistiky.

Hepatoblastoma is an uncommon malignant neoplasm in general, yet, it is the most common liver malignancy in children with the incidence about one per milion children. This type of liver tumor usually occurs before the age of three years. The etiology of hepatoblastoma remains unknown. However, there are some genetic conditions known to be associated with an increased risk of developing hepatoblastoma such as Beckwith-Wiedemann syndrome, hemihypertrophy, APC-associated polyposis, α-1-antitrypsin defficiency and some metabolic disorders including tyrosinemia, galactosemia and glycogen storage disease type 1. There is a higher risk of hepatoblastoma in children with very low birthweight, children who acquire hepatitis B at an early age and children with congenital biliary atresia.

[Fanconi Anemia, Complementation Group D1 Caused by Biallelic Mutations of BRCA2 Gene--Case Report]. / Fanconiho anémie, komplementacní skupina D1 v dusledku bialelické mutace genu BRCA2--kazuistika.

Fanconi anemia is a rare autosomal recessive disorder, clinically and genetically heterogeneous, characterized by typical clinical features, such as short stature, microcephaly, skeletal abnormalities, abnormal skin pigmentations, developmental delay and congenital heart, kidney anomalies etc. Pancytopenia leading to bone marrow failure occurs in the first decade. Patients with Fanconi anemia have a high risk of hematologic malignancies and solid tumors. The diagnosis of Fanconi anemia is based on cytogenetic testing for increased rates of spontaneous chromosomal breakage and increased sensitivity to diepoxybutane or mitomycin C. Fanconi anemia is a heterogeneous disorder, at least 15 complementation groups are described, and 15 genes in which mutations are responsible for all of the 15 Fanconi anemia complementation groups have been identified. Unlike other Fanconi anemia complementation groups, for complementation group D1 (FANCD1), the bone marrow failure is not a typical feature, but early-onset leukemia and specific solid tumors, most often medulloblastoma and Wilms tumor, are typical for this complementation group.

Distinctive MRI features of the epileptogenic zone in children with tuberous sclerosis.

OBJECTIVE: Localization of the epileptogenic zone (EZ) is challenging in children with tuberous sclerosis complex (TSC). We sought to ascertain whether brain MRI could identify the EZ in TSC patients independent of the clinical and diagnostic data. METHODS: Presurgical MRI's of 34 children with TSC who underwent epilepsy surgery at Miami Children's Hospital were retrospectively reevaluated by experts blinded to all other data. Changes typical of TSC (tubers, calcifications, cystic changes) and abnormalities of the perituberal cortex typical of focal cortical dysplasia (FCD) (increased cortical thickness, abnormal gyration, transmantle change, gray/white matter junction blurring) were identified and their localization was compared with the resection site. Sensitivity, specificity and accuracy of individual MRI features to localize the EZ were determined and statistically compared between postoperatively seizure-free and non-seizure-free patients as well as clusters of features typical of FCD and TSC. RESULTS: MRI alone correctly localized the resection cavity in all 19 postoperatively seizure-free patients and 12 of 15 non-seizure-free subjects. Sensitivity, specificity and accuracy of MRI features typical of FCD to localize EZ (90%, 96% and 96%, respectively) were superior to those typical of TCS (79%, 75% and 75%, p<0.0001). Increased cortical thickness and abnormal gyral formation outside tubers occurred only in the resection site. Resection sites were better predicted by MRI in seizure-free than in non-seizure-free patients. CONCLUSION: Thorough MRI evaluation identifies the EZ in a significant proportion of TSC patients. Epileptogenic regions were mostly characterized by "FCD-like" changes outside cortical tubers. The findings may have important practical consequences for surgical planning in TSC.

Technical innovation in minimally invasive repair of pectus excavatum.

The aim of study was to introduce technical innovation of MIRPE which reduces the risk of cardiac injury. Modification of MIRPE method with semiflexible thoracoscope and sternum elevating technique has been used. Volkmann bone hook has been inserted percutaneously to the sternum. The hook elevates the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer. Using semiflexible thoracoscope allows better view from various angles via one site of insertion. During the period 2005-2012, the MIRPE was performed on 29 girls and 151 boys; the mean age at the time of surgery was 15.9 years (range 13-18.7 years). The mean Haller index was 4.7 (range 2.7-20.5). The most common complication was pneumothorax (3.3 %) and the incidence of bar displacement was 2 %. The most serious complication was cardiac perforation when inserting Lorenz introducer. This occurred in a 16-year-old girl; she required urgent sternotomy with right atrial repair and recovered well. External elevation of sternum with the hook was used since this case. Subsequent 113 patients underwent surgery without any serious complications. Technical innovation using semiflexible thoracoscope and hook elevation of the sternum reduces the risk of cardiac injury. The hook opens the anterior mediastinum space effectively and makes the following dissection relatively safe and straightforward.

[Surgical technique changes in the repair of pectus excavatum between 1991 and 2012]. / Zmeny chirurgické techniky pri resení Pectus excavatum v letech 1991-2012.

INTRODUCTION: The aim of this article is a retrospective analysis of the results of three methods used for the repair of pectus excavatum between 1991 and 2012. MATERIAL AND METHODS: 508 patients were operated on at the Department of Paediatric Surgery of the Second Faculty of Medicine, Charles University, and the Teaching Hospital in Motol between 1991 and 2012. 16 patients were older than 19 years (19-28 years). The average age of paediatric and adolescent patients was 14.2 years (5-19 years range). Boys (408) prevailed over girls (82), the ratio being 4.9:1. Open Holcomb technique was used to operate on 87 patients (17%), the Welch method was applied in 208 patients (41%). Minimally invasive repair of pectus excavatum (MIRPE) was used in 213 patients (42%) during the entire period of time. RESULTS: As for the 295 patients operated on by the open Holcomb and Welch method, the outcome was excellent in 239 (81%) of them. A favourable result with a small deformity remaining occurred in 44 patients (15%). Unfavourable result was found in 7 patients (2.5%): in these children, a deep excavation occurred 3-5 years postoperatively. In 5 patients (1.5%) we evaluated the result as recurrent chest wall deformity. The minimally invasive method (MIRPE) produced an excellent result in 182 out of 213 patients (85%). A favourable outcome was observed in 27 (22%), unfavourable result in 1 (0.5%) patient. CONCLUSION: In the last 15 years, minimally invasive repair of pectus excavatum has become popular worldwide. Due to very favourable cosmetic results and a relatively small, gradually decreasing number of complications, the proportion of patients requiring surgery to correct their deformity has risen sharply.