Domains in Action: Understanding Ddi1's Diverse Functions in the Ubiquitin-Proteasome System.

The ubiquitin-proteasome system (UPS) is a pivotal cellular mechanism responsible for the selective degradation of proteins, playing an essential role in proteostasis, protein quality control, and regulating various cellular processes, with ubiquitin marking proteins for degradation through a complex, multi-stage process. The shuttle proteins family is a very unique group of proteins that plays an important role in the ubiquitin-proteasome system. Ddi1, Dsk2, and Rad23 are shuttle factors that bind ubiquitinated substrates and deliver them to the 26S proteasome. Besides mediating the delivery of ubiquitinated proteins, they are also involved in many other biological processes. Ddi1, the least-studied shuttle protein, exhibits unique physicochemical properties that allow it to play non-canonical functions in the cells. It regulates cell cycle progression and response to proteasome inhibition and defines MAT type of yeast cells. The Ddi1 contains UBL and UBA domains, which are crucial for binding to proteasome receptors and ubiquitin respectively, but also an additional domain called RVP. Additionally, much evidence has been provided to question whether Ddi1 is a classical shuttle protein. For many years, the true nature of this protein remained unclear. Here, we highlight the recent discoveries, which shed new light on the structure and biological functions of the Ddi1 protein.

Artificial Intelligence in Medical Imaging: Analyzing the Performance of ChatGPT and Microsoft Bing in Scoliosis Detection and Cobb Angle Assessment.

Open-source artificial intelligence models (OSAIM) find free applications in various industries, including information technology and medicine. Their clinical potential, especially in supporting diagnosis and therapy, is the subject of increasingly intensive research. Due to the growing interest in artificial intelligence (AI) for diagnostic purposes, we conducted a study evaluating the capabilities of AI models, including ChatGPT and Microsoft Bing, in the diagnosis of single-curve scoliosis based on posturographic radiological images. Two independent neurosurgeons assessed the degree of spinal deformation, selecting 23 cases of severe single-curve scoliosis. Each posturographic image was separately implemented onto each of the mentioned platforms using a set of formulated questions, starting from 'What do you see in the image?' and ending with a request to determine the Cobb angle. In the responses, we focused on how these AI models identify and interpret spinal deformations and how accurately they recognize the direction and type of scoliosis as well as vertebral rotation. The Intraclass Correlation Coefficient (ICC) with a 'two-way' model was used to assess the consistency of Cobb angle measurements, and its confidence intervals were determined using the F test. Differences in Cobb angle measurements between human assessments and the AI ChatGPT model were analyzed using metrics such as RMSEA, MSE, MPE, MAE, RMSLE, and MAPE, allowing for a comprehensive assessment of AI model performance from various statistical perspectives. The ChatGPT model achieved 100% effectiveness in detecting scoliosis in X-ray images, while the Bing model did not detect any scoliosis. However, ChatGPT had limited effectiveness (43.5%) in assessing Cobb angles, showing significant inaccuracy and discrepancy compared to human assessments. This model also had limited accuracy in determining the direction of spinal curvature, classifying the type of scoliosis, and detecting vertebral rotation. Overall, although ChatGPT demonstrated potential in detecting scoliosis, its abilities in assessing Cobb angles and other parameters were limited and inconsistent with expert assessments. These results underscore the need for comprehensive improvement of AI algorithms, including broader training with diverse X-ray images and advanced image processing techniques, before they can be considered as auxiliary in diagnosing scoliosis by specialists.

Artificial Intelligence in Scoliosis Classification: An Investigation of Language-Based Models.

Open-source artificial intelligence models are finding free application in various industries, including computer science and medicine. Their clinical potential, especially in assisting diagnosis and therapy, is the subject of increasingly intensive research. Due to the growing interest in AI for diagnostics, we conducted a study evaluating the abilities of AI models, including ChatGPT, Microsoft Bing, and Scholar AI, in classifying single-curve scoliosis based on radiological descriptions. Fifty-six posturographic images depicting single-curve scoliosis were selected and assessed by two independent neurosurgery specialists, who classified them as mild, moderate, or severe based on Cobb angles. Subsequently, descriptions were developed that accurately characterized the degree of spinal deformation, based on the measured values of Cobb angles. These descriptions were then provided to AI language models to assess their proficiency in diagnosing spinal pathologies. The artificial intelligence models conducted classification using the provided data. Our study also focused on identifying specific sources of information and criteria applied in their decision-making algorithms, aiming for a deeper understanding of the determinants influencing AI decision processes in scoliosis classification. The classification quality of the predictions was evaluated using performance evaluation metrics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and balanced accuracy. Our study strongly supported our hypothesis, showing that among four AI models, ChatGPT 4 and Scholar AI Premium excelled in classifying single-curve scoliosis with perfect sensitivity and specificity. These models demonstrated unmatched rater concordance and excellent performance metrics. In comparing real and AI-generated scoliosis classifications, they showed impeccable precision in all posturographic images, indicating total accuracy (1.0, MAE = 0.0) and remarkable inter-rater agreement, with a perfect Fleiss' Kappa score. This was consistent across scoliosis cases with a Cobb's angle range of 11-92 degrees. Despite high accuracy in classification, each model used an incorrect angular range for the mild stage of scoliosis. Our findings highlight the immense potential of AI in analyzing medical data sets. However, the diversity in competencies of AI models indicates the need for their further development to more effectively meet specific needs in clinical practice.

Assessment of the Functioning Profile of Patients with Lung Cancer Undergoing Lobectomy in Relation to the ICF Rehabilitation Core Set.

Lung cancer often presents with pain and breathlessness, frequently necessitating surgical procedures, such as lung lobectomy. A pivotal component of postoperative care is rehabilitation, aimed not only at improving the clinical condition but also at influencing the patient's functional profile. In a study conducted at the Clinic of Thoracic Surgery and Respiratory Rehabilitation in the Regional Multispecialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, the effectiveness of rehabilitation intervention was assessed in 50 patients (n = 27 M, n = 23 F) postlobectomy due to early stage nonsmall cell lung cancer (NSCLC). The International Classification of Functioning, Disability, and Health-ICF Rehabilitation Core Set was used to evaluate the functional profile, the modified Laitinen scale for pain assessment, and the modified Borg scale for breathlessness evaluation. Additionally, lung-expansion time was monitored. The significance level of the statistical tests in this analysis was set at α = 0.05. The study employed an analysis of the normality of the distributions of the numerical variables, reporting of variable distributions, estimation of differences between groups, estimation of differences within groups, estimation of the independence of categorical variables, and regression analysis. The research confirmed that rehabilitation partially improves the functional profile of patients and reduces the sensation of breathlessness postsurgery. The study highlighted the need for future research with a larger number of participants and an extended observation period to gain a deeper understanding of the impact of rehabilitation on patients after lung lobectomy procedures.

Evaluating Scoliosis Severity Based on Posturographic X-ray Images Using a Contrastive Language-Image Pretraining Model.

Assessing severe scoliosis requires the analysis of posturographic X-ray images. One way to analyse these images may involve the use of open-source artificial intelligence models (OSAIMs), such as the contrastive language-image pretraining (CLIP) system, which was designed to combine images with text. This study aims to determine whether the CLIP model can recognise visible severe scoliosis in posturographic X-ray images. This study used 23 posturographic images of patients diagnosed with severe scoliosis that were evaluated by two independent neurosurgery specialists. Subsequently, the X-ray images were input into the CLIP system, where they were subjected to a series of questions with varying levels of difficulty and comprehension. The predictions obtained using the CLIP models in the form of probabilities ranging from 0 to 1 were compared with the actual data. To evaluate the quality of image recognition, true positives, false negatives, and sensitivity were determined. The results of this study show that the CLIP system can perform a basic assessment of X-ray images showing visible severe scoliosis with a high level of sensitivity. It can be assumed that, in the future, OSAIMs dedicated to image analysis may become commonly used to assess X-ray images, including those of scoliosis.

Congenital Anterior Dislocation of the Sacrococcygeal Bone in a Newborn.

We present a case of a child who was transported to the Neurosurgery Clinic from another hospital for the purpose of performing a surgical procedure of the spinal myelomeningocele. On the first day of the stay, a set of tests was performed, including an anterior-posterior (AP) projection X-ray, which clearly showed a developmental defect in the lumbar-sacral section of the spine. In the follow-up physical examination, there was a depression of the skin on the right side of the surgical scar after closing the open myelomeningocele. In the follow-up MRI of the lumbar-sacral section, an extremely rare congenital anterior dislocation of the sacrococcygeal bone was unexpectedly visualized. Despite recommendations for further diagnostics, the patient did not attend the required follow-up examinations. In the final section, we provide a general summary of the literature on rare developmental defects of the spine in children.

Telovelar versus transvermian approach to tumors of the fourth ventricle and their impact on postoperative neurological complications: A multicenter study.

Background: Tumors of the fourth ventricle are exceedingly rare; however, such lesions are formidable due to the severe postoperative neurological complications (pNCs) which often occur. The adoption of the telovelar approach over the transvermian was created to supposedly mitigate the pNCs; however, there is a lack of sufficient data supporting this theory. Methods: Records from six hospitals were reviewed for patients surgically treated for a single tumor within the 4th ventricle from 2016 to 2022. The pNCs which had 10 or more occurrences among the patients were individually assessed as the dependent variable in a binary logistic regression model against covariates which included the surgical approach. Results: This study of 67 patients confirms no significant differences in risk for pNCs between the transvermian and telovelar approach. Rather, multivariate analysis identified neurophysiological monitoring (IONM) as a protective factor for postoperative speech and swallowing defects (odds ratio [OR]: 0.076, 95% confidence interval [CI] 0.011-0.525). Furthermore, intraoperative external ventricular drainage (EVD) was a protective factor for postoperative gait and focal motor defects (OR: 0.075, 95% CI 0.009-0.648) and for postoperative hydrocephalus (OR: 0.020, 95% CI 0.002-0.233). A univariate meta-analysis pooling the present study's patients and an additional 304 patients from the three additional studies in the literature confirms no significant differences in risk between the transvermian and telovelar approach for pNCs. Conclusion: Intraoperative adjuncts including IONM and EVD may play a significant role in the postoperative outcome. Despite the present study's sample size being a major limitation, the findings may provide great value to neurosurgeons given the scarcity of the current literature.

Superior Hypophyseal Artery Ruptured Aneurysm in a 5-Month-Old Child Presenting as an Acute Subdural Hematoma: A Case Report.

INTRODUCTION: We present a very rare case of ruptured superior hypophyseal artery (SHA) aneurysm that presented as an acute subdural hematoma (SDH) discussing its initial presentation, diagnosis, and treatment modalities. To our knowledge it is one of very few if any cases of a ruptured aneurysm in infants regarding that specific vascular location. CASE REPORT: A 5-month-old boy was referred to our department due to acute SDH over the right cerebral hemisphere without significant mass effect nor hydrocephalus. Further evaluation revealed a right internal carotid artery (ICA) aneurysm arising from the SHA segment. Microsurgical clip ligation using a fenestrated, angled clip was performed with simultaneous subdural clot removal and proximal control of the ICA dissected in the neck. Our patient made an excellent recovery without any complicating features. CONCLUSION: Surgical management seems to be a better option in this subgroup of patients given the long life expectancy and durability of microsurgical clip ligation. We believe that our brief case report would add some insight into the management of this rare subgroup of patients, leading to better decision-making and outcome.

CSF levels of myelin basic protein in pediatric patients with ventriculoperitoneal shunt infection.

INTRODUCTION: Hydrocephalus is a common disorder of the central nervous system (CNS) in the pediatric population. Surgical treatment options involve ventriculoperitoneal shunt (VPS) placement. VPS infection is the most common complication of surgically treated hydrocephalus in pediatric patients [1, 2],which may lead to neuronal damage. Myelin basic protein (MBP) has been proposed as a marker of neuronal injury in a variety of contexts, and MBP levels in the cerebrospinal fluid (CSF) may be used to assess the severity of neuronal damage [1, 3, 4]. Therefore, the aim of this study was to evaluate the CSF level of myelin basic protein (MBP) in a group of pediatric patients with VPS infection. MATERIAL AND METHODS: Thirty CSF samples were collected from pediatric patients with VPS infection. CSF levels of MBP were measured at three time points, marked by contamination detection, obtention of the first sterile CSF culture, and VPS shunt implantation. The collected data were compared with those of the control group composed of children with active congenital hydrocephalus and valid CSF values. RESULTS: The MBP level in the study group was higher than the corresponding control values in the second and third measurements. The highest MBP level was reached in the study group in the second and third measurements. CONCLUSIONS: The lack of normalization of MBP level in the CSF of children with shunt infection could be connected with ongoing brain damage. It takes longer than the normalization of CSF protein level and pleocytosis. The delay is associated with a prolonged reaction of the immunological system.

Predicting conservative treatment failure in patients with lumbar disc herniation. Single center, case-control study.

OBJECTIVES: The aim of this study was to identify independent predictors of conservative treatment failure in patients presenting due to lumbar disc herniation-associated low back pain and sciatica. PATIENTS AND METHODS: This is a single institution, case-control study including 240 patients that were selected for microsurgical or conservative treatment due to lumbar disc herniation in a 2,5-year period. Bivariate and multivariate analyses were performed in order to identify independent predictors among demographic, clinical and radiographic factors. RESULTS: Statistically significant differences were observed between conservatively and surgically managed groups in bivariate analysis. Logistic regression models further revealed that leg paresthesia (p =  0,003; OR = 5,136) and percentage of spinal canal stenosis ratio (p < 0,001; OR = 1,055) had the strongest, independent correlation with conservative treatment failure in our cohort. Back-to-leg ratio did not reach statistical significance although it proved a strong correlation in bivariate analysis (p < 0,001, Cramér's V = 0,53). CONCLUSION: Increasing % canal compromise ratio (cut-off value 23%) and co-occurrence of leg paresthesia were the most important risk factors for surgery in our series of patients.

Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS).

PURPOSE: The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. METHODS: We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. RESULTS: Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. CONCLUSION: ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.

Surgical treatment of post-inflammatory hydrocephalus. Analysis of 101 cases.

OBJECTIVE: The aim of this paper was to evaluate the outcomes of surgical treatment for post-inflammatory hydrocephalus in pediatric patients. The patient's age, surgical technique and type of implants, revision rate (depending on the cause for revision and shunt type), and final outcome measured with Neurologic Outcome Scale for Infants and Children (NOSIC) scale were evaluated. METHODS: We performed a retrospective analysis of 101 patients with post-inflammatory hydrocephalus, treated in Polish Mother's Memorial Hospital Research Institute since 2005. Children with comorbidities (e.g., tumors or hemorrhages) were excluded from the study. The assessment included patient age, surgical technique (ventriculoperitoneal shunt (VPS) or neuroendoscopy) and type of implant, revision rate (considering its cause), and final outcome measured in Neurologic Outcome Scale for Infants and Children (NOSIC) scale. RESULTS: VPS implantation was the most common surgical technique. It was performed in 66.33% (n = 67) of cases. Neuroendoscopic procedure was used in 33.66% of cases (n = 34). Revision rate of VPS was 52.23% (n = 35). Endoscopic third ventricle ventriculostomy (ETV) was efficient only in 5 cases (14.7%), whereas in 29 cases (85.3%), it was followed by VPS implantation. Revision rate in VPS implantation after ETV reached 55.17% (n = 16). In all age groups, VPS implantation was the most frequently used procedure. Revisions of the shunt systems occurred most frequently in the 1-3 (n = 21 41.18%) and < 1 (n = 12, 23.53%) age ranges. The type of valve that most often underwent dysfunction was flow-regulated type (n = 23, 62.16%). The type of valve that was the least frequently revised was differential pressure type (n = 11, 17.18%). In all age groups, mechanical dysfunction was the most frequent cause of shunt disability. Average NOSIC score ranged from 39 to 98 (average 80.58, standard deviation ± 13.34). NOSIC result relative to individual operational techniques was as follows: ETV + VPS-80.17 (n = 29, standard deviation ± 11.44), VPS-80.44 (n = 67, standard deviation ± 14.30), and ETV-80.80 (n = 5, standard deviation ± 11.62). There was no difference between the outcome of the NOSIC and the type of implanted valve or its dysfunction. CONCLUSIONS: In our analysis, post-inflammatory hydrocephalus accounts for 11.7% of all hydrocephalus types. Of post-inflammatory hydrocephalus, multiloculated type accounts for 14.9%. The most common type of surgery in these patients is implantation of the ventriculoperitoneal system. The most frequent revisions of the VPS system occur in the group of the younger children (< 3). The most common type of a dysfunction shunt is the differential pressure valve, and the rarest type the flow-regulated type. In the case of mechanical dysfunction, occlusion of the intraventricular catheter is the most common reason. ETV does not affect the frequency of VPS revisions. The average NOSIC score in children treated with hydrocephalus is below normal, and the best results are observed in the youngest children.

Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection.

PURPOSE: The aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120-123, 2017; Hayhurst et al. Childs Nerv Syst 24:557-562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795-1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131-136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792-797, 2012). METHODS: The study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation. RESULTS: In the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins. CONCLUSION: CSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.

The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus-a preliminary report.

INTRODUCTION: Recognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly. AIM: The aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus. MATERIALS AND METHODS: A group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms. RESULTS: The peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters. CONCLUSION: Phase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient-technical note.

PURPOSE: The aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture. METHODS: A 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®-Vexim™) and cement (Interface®-Vexim™) under fluoroscopic imaging (Ziehm™ 8000®). RESULTS: The whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free. CONCLUSION: The extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

A hybrid technique for ventriculoatrial shunt implantation--technical note.

PURPOSE: The aim of the article is to present the new hybrid technique for ventriculoatrial shunt implantation. METHODS: Two-and-a-half-year-old boy needed ventriculoatrial shunt implantation due to communicating hydrocephalus and impaired absorptive ability of the peritoneum. Because of a complete occlusion of the right internal jugular vein and critical stenosis of a distal part of the left internal jugular vein, the procedure was performed under fluoroscopy guidance in the catheterisation laboratory equipped with a 3-dimensional single plane angiography machine (Philips Allura--The Netherlands). At the level of critical stenosis of the left jugular vein, it was decided to perform a percutaneous venous balloon angioplasty. This procedure allowed inserting the ventriculoatrial shunt into the right atrium. RESULTS: The whole postoperative period was uneventful. Now, the child is free from symptoms of increased intracranial pressure. The boy has been followed for 9 months. In the control MRI examination, the ventricular system did not change as compared with the previous study. CONCLUSION: The disadvantage of the hemodynamic technique is a higher dose of X-ray irradiation in comparison to other techniques. The hybrid technique should be reserved only to very complicated cases.

The long-term psychological effects of surgical treatment using neuroendoscopic techniques and Orbis Sigma shunt implantation in children suffering from hydrocephalus.

BACKGROUND: Hydrocephalus, which is the most common disease of the central nervous system in children, has a diverse etiology and clinical picture. Children suffering from hydrocephalus are often treated either by using a neuroendoscopic procedure or by Orbis Sigma shunt implantation. OBJECTIVES: To evaluate the long-term psychological effects of neuroendoscopic surgical treatment on the mental development and cognitive abilities of children suffering from hydrocephalus, in comparison with the results following Orbis Sigma shunt implantation, and to assess the impact of the kind of hydrocephalus on the outcome of the treatment. MATERIAL AND METHODS: The study involved 78 patients treated surgically for chronic noncommunicating hydrocephalus: 39 patients who had undergone neuroendoscopic surgery (average age: 12 years, SD +/- 7 years), and 39 who had undergone implantation of a ventriculo-peritoneal shunt (average age: 14 years +/- 5 years). The psychomotor development of the two groups was analyzed using psychomotor development tests including the Brunet-Lezine test, the Terman-Merrill test, Raven's Standard Progressive Matrices, Raven's Colored Progressive Matrices, the Benton Visual Retention Test, the Bender Visual Motor Gestalt Test, the Rey Fifteen-Item Memory Test, lateralization tests and a questionnaire. RESULTS: In the shunt group there were statistically significant prevalences hydrocephalus diagnosed perinatally and in the first year of life (p = 0.0291), epileptic seizures (p = 0.0181), intellectual disability (p = 0.0049) and gait disturbances (p = 0.006). There were statistically significant differences between two groups in the relative changes of linear measurements of the cerebral ventricle depending on the type of treatment: Relative Frontal Horn Index (RFHI): 0.93 following endoscopy and 0.64 following shunt implantation; Relative Evans' ratio (RER): 0.93 following endoscopy and 0.62 after shunt implantation; Relative Frontal and Occipital Horn Ratio (RFOHR): 0.89 after endoscopy and 0.69 after shunt implantation. The time treatment was undertaken and the incidence of mental retardation did not differ significantly between the two groups. CONCLUSIONS: The analysis of cerebral ventricle enlargement expressed in linear ventricular enlargement measurements revealed statistically important differences in the intellectual, cognitive and motor development between the groups treated with the two neurosurgical techniques.

Pilocytic astrocytoma as a predominant component of a recurrent complex type DNT.

Dysembryoplastic neuroepithelial tumour (DNT) is a benign lesion of the cerebral hemispheres usually presenting minimal biological activity after surgical excision. We report an unusual case of a 7-year-old girl with a temporal lobe DNT, which recurred four years after subtotal resection of the tumour. In the recurrent lesion we identified pilocytic astrocytoma (PA) as a predominant component of the tumour. Small pieces of the removed tissues also disclosed remnants of DNT. Clinical presentation of the primary tumour consisted of partial simple seizures, while the recurrent tumour manifested with headache and vomiting. Likewise, the radiological appearance of both tumours was different. We conclude that patients with incompletely removed DNT may suffer local recurrence of that tumour. In rare cases development of a secondary, histologically different neoplasm may also occur.

Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods.

OBJECTIVE: The authors intended to evaluate the application of neuroendoscopic techniques for the treatment of arachnoid cysts in children and compare it with other operative methods. METHODS: The analysis covered the results of treatment of 44 children with arachnoid cysts who were subjected to neuroendoscopic procedures and 62 patients who underwent other operations. RESULTS: The neuroendoscopic treatment of arachnoid cysts was very effective because of low rate of reoperative treatment (six out of 44 patients), no need to change the operative method (40 effective out of total 44 operative procedures), and low rate of persistent worsening (none of 44 patients worsened). CONCLUSIONS: Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.

Influence of neuroendoscopic third ventriculostomy on the size of ventricles in chronic hydrocephalus.

Our intention was to compare the clinical outcome after surgical treatment of chronic hydrocephalus between patients who were subjected to neuroendoscopic third ventriculostomy and patients who underwent shunt implantation. At the Department of Neurosurgery of the Research Institute of Polish Mothers' Memorial Hospital from 1999 to 2001, 29 children, of an average age of 7 years (+/-7.1 years SD), underwent successful neuroendoscopic procedures, and from 1992 to 1994, 59 children, of an average age of 2 months (+/-1.9 months SD), underwent shunt implantation. The size of the ventricular system was described by the Frontal Horn Index and its change after operative procedures by the ratio of the final to the primary Frontal Horn Index. Head circumference was measured in percentiles according to the Kurniewicz-Witczakowa chart for Polish children. The reduction in head circumference after a neuroendoscopic procedure was, on average, significantly less than after a shunt implantation (0.39 percentiles +/-29.6 SD vs 17.93 percentiles +/-19.93 SD). Concerning the change in ventricular size after a neuroendoscopic procedure, it was noticed that the average ratio of the final to the primary Frontal Horn Index was 0.9. Meanwhile, the same parameter after a shunt implantation was 0.55. Based on the values of the Frontal Horn Indexes, it was observed that the ventricular system in infants after neuroendoscopic procedures was significantly larger than in other age groups (0.7 vs 0.5). After successful neuroendoscopic operations in a group of children suffering from Chiari II malformation, ventricular systems were slightly enlarged. The ratio of the final Frontal Index to the primary Frontal Horn Index was 1.31. In children suffering from chronic hydrocephalus, the average reduction in the size of the ventricular system and the rate of head circumference growth are lower after neuroendoscopic operations than after shunt implantations. Successful neuroendoscopic procedures are characterized by, on average, a higher rate of head circumference growth in infants than in neonates. In addition, the rate of head circumference growth after successful neuroendoscopic procedures could be higher than before the operation, which is clearly visible in children suffering from Chiari II malformation, but it does not mean a constant increase of that parameter during the postoperative period.