[Neurosurgical management for metastatic brain tumors in renal cell carcinoma]. / Oligometasztatikus vesesejtes karcinóma idegsebészi ellátásának technikái és indikációi agyi áttétek esetén.

The therapeutic approach to brain metastases has changed significantly in the last 30 years. The development of surgical technique, the use of new MRI techniques, preoperative surgical planning and the administration of intraoperative navigation reduced the risks of surgery and improved the results. In the case of aggressive renal cell carcinomas, we detect brain metastases relatively often, which are difficult to treat, but the improved surgical and radiosurgery techniques can also be used with success. In our report, we present the neurosurgical management of metastatic spreading of renal cell carcinoma to the brain. Modern surgical planning and more precise, tailored approach with modern radiosurgery techniques are able to improve the outcome and prolong survival even in aggressive types of renal cell carcinomas that give rise to brain metastases. In more severe cases and even in the case of multiple brain metastases, cranial surgery can be recommended.

[Techniques and indications of neurosurgical treatment of oligometastatic renal cell carcinomas in case of spinal metastases]. / Oligometasztatikus vesesejtes karcinóma idegsebészi ellátásának technikái és indikációi gerincáttétek esetén.

The treatment of spinal metastases is a huge challenge, but both oncological and surgical treatment have improved significantly. Spine surgeons use the experience of spine surgeries performed for an increased number of degenerative causes during spine surgeries performed for an increased number of tumors. Establishing an indication for surgery is at least as much of a challenge as the surgery itself, for which there are many objective point systems available. Renal cell carcinoma metastases are less sensitive to radiation, which is why careful surgery is even more important. In our short summary, we review the symptoms, the examination, the grading systems used and the surgical options.

An Unusual Case (Metastatic-Like Lesion) of Septic Cerebral Embolus Caused by Corynebacterium mucifaciens in a Diabetic Patient.

Septic cerebral emboli can be a challenging diagnosis to give, especially if atypical bacterial infections are the cause of it. Correct diagnosis of this condition can change the management route of the patient and result in a nonsurgical treatment. To our best knowledge, this is the first case of septic cerebral embolus caused by Corynebacterium mucifaciens reported. In this study, a 65-year-old diabetic patient who have developed ketoacidosis and went into coma was investigated for a case of septic cerebral embolization. The patient developed a sudden right-sided hemiparesis, and the radiological findings showed a tumor-like lesion on the left hemisphere at the level of the internal capsule. At first glance, presence of a metastatic tumor could not be excluded; therefore, further laboratory tests and examinations were done to rule out metastatic lesions. The blood culture of the patient revealed a case of bacteremia caused by Corynebacterium mucifaciens and then a septic cerebral embolus was suspected, but due to the rarity of this pathogen causing such complications as well as the similarity of the lesion to a metastatic brain tumor, a biopsy was performed and the histopathological findings confirmed the diagnosis of a septic cerebral embolus. Corynebacterium mucifaciens should be considered a human pathogen in immunocompromised patients and it can cause cerebral septic embolization. Metastatic brain tumors and tuberculomas should be excluded; if the uncertainty of a metastatic tumor remains, biopsy can be performed and histological findings can amplify the diagnosis of septic cerebral embolus.

Slit Ventricle as a Neurosurgical Emergency: Case Report and Review of Literature.

BACKGROUND: Symptomatic slit ventricle is one of the most challenging complications of shunt surgery in children. Clinical signs and symptoms may appear with a wide range of intracranial pressure (ICP) values. We report the case of a 10-year-old girl, who did not present the classic clinical features of extremely elevated ICP, which was proven by multiple invasive ICP recordings, performed during shunt revisions. CASE DESCRIPTION: At the age of 6 months, the patient presented squeal for many hours, accompanied with sunset eyes, bulging anterior fontanel, and dilated ventricles of all 4 ventricles on computed tomography scan. Acute ventriculoperitoneal shunt insertion was performed with adjustable valve. During the following 9 years, she was regularly seen and medically treated for intermittent headache, with nausea and vomiting. From 9 years of age, she was hospitalized for severe (10/10 on the visual analog scale), unbearable headache, agitation, and screaming on multiple occasions. Altogether, we had to revise the shunt system 5 times throughout 1 year. Radiologic imaging always showed narrow ventricles. Ophthalmologic examination of the fundus never revealed signs of raised ICP. Perioperative monitoring of the ICP with intraparenchymal sensor showed unexpected high values of 40-45 mm Hg. However, repetitive shunt revisions were successful only temporarily because the symptoms always returned. Only bilateral shunting of the ventricular system was able to eliminate the symptoms permanently. CONCLUSIONS: Images of slit ventricle can be associated either with low or extremely high ICP needing urgent surgical consideration, including ICP monitoring. Bilateral shunt insertion can be effective treatment for slit ventricle syndrome.

[Early experience with minimal invasive treatment of thirty-one thoracolumbar injury cases]. / Korai tapasztalataink thoracolumbalis gerincsérülések minimálinvazív mutéti kezelésével.

The authors report on their experience with minimal invasive treatment of thirtyone thoracolumbar injury cases. The medical charts, radiological documentation (preop CT and MRI scans, postop CT scans at 3 and 6 months) were analysed retrospectively. All pedicle screws were inserted appropriately, there was no neurological deterioration or surgical site infection postoperatively. There were three cases of radiological loss of correction, however, these were clinically irrelevant. There were no screw loosening or implant failure observed. According to our experience, which coincedes with literature data, this minimally invasive percutaneous pedicle screw technique can be recommended for the treatment of thoracolumbar injury.

[Factors affecting the development of chronic hydrocephalus following subarachnoid hemorrhage, with special emphasis on the role of ventricular and lumbar drainage]. / A subarachnoidealis verzest követô krónikus hydrocephalus kialakulását befolyásoló tényezôk vizsgálata, különös tekintettel a kamrai és az ágyéki liquordrenázs szerepére.

Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage. Numerous studies have dealt so far with the triggering cause of the chronic cerebrospinal fluid (CSF) absorptional and circulatory disorders. Despite the fact that these studies gave several different explanations, most of them agreed on the fact that the obstruction of CSF pathway has a crucial role in the development of the clinical feature. By examining three years' clinical cases, the authors were trying to find out which are the factors that influence the development of the late hydrocephalus which follows the subarachnoid hemorrhage; moreover to find out if the incidence of the latter may be decreased by a continuous drainage of CSF which advances its purification. One hundred and seventy-one patients (one hundred and twenty-seven females) were treated by aneurysmal SAH at Department of Neurosurgery, University of Szeged between 2002 and 2005. The following parameters were recorded: gender, clinical state, risk factors (smoking, consuming alcohol and hypertension), the method and the time of surgical treatment as well as CSF drainage. The studies have shown that the risk of incidence of chronic hydrocephalus were higher in men and in case of severe clinical state with severe SAH. The disturbed CSF circulation and/or absorption were positively correlated with consuming alcohol and hypertension, while smoking did not affect it. The rate of the incidence of chronic hydrocephalus among our patients was lower (5.8%) compared to the results of other studies (7-40%) suggests that disturbance of CSF circulation and/or absorption may be avoided in the majority of cases by continuous external ventricular or lumbar CSF drainage, which is applied routinly.

[Preliminary experience with controlled lumbar drainage in medically refractory intracranial hypertension]. / Spinalis liquorlebocsátással szerzett kezdeti tapasztalatok koponyasérülést követo befolyásolhatatlan intracranialis nyomásfokozódás kezelésében.

INTRODUCTION: The contribution of brain edema to brain swelling in cases of traumatic brain injury remains a critical problem. In head injury, the swelling and eventual rise in intracranial pressure is a frequent cause of death, and in survivors the poor prognosis with sustained elevation of ICP has been well documented. OBJECTIVE: The objective this study was to evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension following severe brain injury. METHOD: The study involved 10 head injured patients (GCS < or = 8) with medically refractory intracranial hypertension. Aggressive treatment included the repeated steps of the Brain Trauma Foundation's guidelines, barbiturate coma and in many cases decompressive craniectomy as well. After institution of a lumbar drain, cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and neurological status. ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. RESULTS: All patients demonstrated an immediate decrease of ICP (from 30.6 +/- 4.7 mm Hg to 11.5 +/- 3.9 mm Hg, mean +/- SD) and a concomitant increase of cerebral perfusion pressure. In seven patients the decrease of ICP was long lasting and 5 of them had a favourable outcome. Two patients survived with a severe permanent neurologic deficit and only three patients died because of the progressive brain edema, which developed despite of the maximum therapy. CONCLUSION: In conclusion we may consider, that controlled lumbar cerebrospinal fluid drainage is a potentially useful treatment in cases of severe traumatic brain injury when maximal medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high intracranial hypertension. The danger of herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.