Cerebral gangliogliomas. Morphological and immunohistochemical study.

Report concerns 6 uncommon cases of cerebral ganglioglioma in adult patients, the majority of whom (4) demonstrated typical classic features, others were anaplastic. Both types presented neuronal and glial components characterized either by NF, NSE and Syn or GFAP immunoreactivity. Only the tumor of the youngest patient presented moderate desmoplasia. Observations indicate at an easy classification of glial component contrary to neuronal component in relation to the origin of neuronal changes.

Supratentorial astrocytoma associated with arteriovenous malformation. Case report.

A case of the 18-year-old boy suffering from epilepsy since 8 years and suspected of microangioma is presented. The craniotomy revealed left parietal parasagittal superficially located neoplasm and arteriovenous malformation beneath. Unexpected fibrillary astrocytoma associated with vascular tumor was the diagnostic problem, solved histologically after the operation. The problem of coexistence of various neoplasms with arteriovenous malformations is discussed.

Disorganization of cortical structure and the brain tumors.

In the course of histopathological investigation of the temporal lobe sections, selected from 63 patients treated surgically for intractable epilepsy and finally presented with primary temporal tumors, we found 12 cases expressed both neoplastic process' and developmental disorders. The temporal mass lesions consisting of neuro-glial or pure glial tumors were associated with some developmental abnormalities such as cortical dysplasia, neuronal heterotopias and additional cortical neoplastic nodules. The possible "dual pathology" concerning these lesions are discussed in this paper.

[Pathogenesis of syringomyelia in the light of our observations]. / Patogeneza jamistosci rdzenia w swietle wlasnych spostrzezeý

The author treated surgically 10 patients with syringomyelia. In 6 cases Arnold--Chiari syndrome was found, in 2 cases platybasia with basilar impression, besides that 2 patients had complete or partial occlusion of Maganide's foramen and in 4 cases a persisting central canal communicated widely with the 4th ventricle. In 3 cases these findings were associated with postinflammatory changes. In only one case the changes in the atlanto-occipital area could not have been defined clearly. The author compares his observation with those reported by others reaching the conclusion that they confirm the hydrodynanic mechanism of syringomyelia. In most cases syringomyelial is a result of congenital or congenital and acquired malformations in the medullo-bulbar area leading to distrubances in the circulation of cerebrospinal fluid.

[Surgical treatment of Parkinson's disease in Poland in the last century]. / Operacyjne leczenie choroby Parkinsona w Polsce w ubieglym stuleciu.

Surgery of Parkinson's disease started in the middle of the last century. At the same time this treatment was introduced in Poland. Choróbski removed Broadsman's area 4 through craniotomy. In 1961 Liszka in Kraków introduced the stereotactic procedures, thalamo- and pallidotomy. This type of surgery was soon introduced in two other neurosurgical centers. For the next several years treatment was mostly pharmacological. However, stereotactic treatment was used in patients poorly tolerating drugs. In the meantime first attempts were made at implantation of fetal substantia nigra, with good results. At the end of the century in several patients electrostimulators were implanted. In the last century all known methods of surgical treatment were applied in Poland.

[Terminal ventriculostomy in the treatment of syringomyelia]. / Ventriculostomia terminalis (wentrykulostomia koncowa) w leczeniu jamistosci rdzenia.

Terminal ventriculostomy is one of the methods used in surgical treatment of syringomyelia. The procedure is well tolerated and may be used in cases in which atlanto-occipital decompression is too serious an operation. The author used the method in treatment of 10 patients with different stages of syringomyelia. In 5 cases the time of follow-up was 12--20 months, in 2 of them the result was very good with very great improvement, in 3 improvement was slight but the progression of the disease was halted. In 5 cases with shorter follow-up improvement was observed in 3 and no improvement immediately after the operation in 2 cases. Further follow-up of these patients will show whether the results of the operation will be permanent.

[Prevention of infection in neurosurgery]. / Profilaktyka zakazen w neurochirurgii.

The dangers connected with postoperative wound infection, especially in neurosurgery, are discussed, together with various methods of reduction in the pertinent literature and used in various clinical centres. The review shows that properly used perioperative prophylaxis has reduced markedly the incidence of wound infection, even to zero in elective clean neurosurgical operations. The antibiotics used for this purpose are described, and indications are given concerning the selection of proper antibiotics.

[On epilepsy prevention after intracranial aneurysm surgery]. / W sprawie profilaktyki padaczki po operacjach tetnaików wewnatrzczaszkowych.

The authors evaluate in the presented prospective study the incidence of late epilepsy after aneurysm surgery. 121 consecutive patients were operated on for ruptured aneurysm and were discharged home without any prophylactic anticonvulsant treatment and were followed-up for 12 months. The diagnosis of late epilepsy was made, if two or more seizures occurred during that time. Epilepsy occurred in 8 patients, so the incidence was 7%. Additionally in 3 patients a single seizure was observed during follow-up time but any anticonvulsant treatment was installed and the seizures did not recur for up to 24 months. The analysis of epileptic patients showed that in most of them the aneurysm was located on MCA and SAH was complicated by intracerebral haematoma or symptomatic vasospasm. On the basis of own experience and review of the literature the authors discuss the necessity of anticonvulsant prophylaxis after aneurysm surgery.

[Clinical patterns of Arnold-Chiari malformations]. / Postacie kliniczne zespolu Arnolda-Chiari.

The purpose of the study was clinical analysis of the patients with Arnold-Chiari malformation and the definition of the groups according to the clinical presentation. The authors present the series of 210 patients treated between 1980 and 1997 in the Department of Neurosurgery. These patients were classified into 4 groups: syringomyelia, cerebellar syndrome, cerebello-spinal syndrome and hydrocephalus. Syringomyelia was the commonest clinical presentation in the series. Less often cerebellar and cerebello-spinal syndromes were observed. Non-communicating hydrocephalus was rare. The symptomatology of the Arnold-Chiari malformation appears extremely variable, but most often is related to the associated cavitation of the spinal cord. The signs and symptoms in patients presenting cerebellar syndrome may lead to misdiagnosis of insufficiency of the vertebrobasilar circulation. Diffuse involvement of the motor and sensory system with cerebello-spinal syndrome may cause the patient to be diagnosed incorrectly as having sclerosis multiplex. The MR is the method of choice in the diagnosis of Arnold-Chiari malformation.

[Surgical treatment of epilepsy: current status and results of own observations]. / Operacyjne leczenie padaczki--stan obecny i wyniki w swietle wlasnych spostrzezen.

New diagnostic possibilities make possible a more precise localization of epileptogenetic foci and surgical treatment of epilepsy is associated presently with minimal risk. This was the reason of a surge of interest in recent years even in those countries where this method has not been used. In our country operations for chronic refractory epilepsy have been performed since over 35 years and the gathered experience is sufficient to reach conclusions about the results. The results depend in a certain degree on the location of the focus and the surgical possibility of its removal. In about 50% of the cases cure was effected, and in 15% improvement was achieved near cure. Considering that the treated patients had long-standing and refractory epilepsy with very frequent seizures the results of surgical removal of epileptogenic focus were very good. The authors believe that patients with chronic, focal and refractory epilepsy should be treated surgically, and conservative treatment without considering this possibility is erroneous.

[Surgical treatment of intracranial arachnoid cysts]. / Uwagi o leczeniu operacyjnym wewnatrzczaszkowych torbieli pajeczynówkowych.

The results of surgical treatment in 21 cases of intracranial arachnoid cysts, mostly in adults, are reviewed. There were 19 supratentorial and 2 infratentorial cysts. In all but one supratentorial cyst cases epileptic seizures were the major clinical presentation. CT scan was helpful in the diagnosis in most cases. In 7 patients CT-cisternography was performed and in 3 cases a connection of cyst cavity to intracranial cerebrospinal fluid space was demonstrated. The cysts were treated surgically in different ways including craniotomy for fenestration of cyst wall, resection of cyst wall and neighbouring cerebral structures or cyst-peritoneal shunting. In some cases successive surgical treatment was necessary since the initial surgery proved to be unsuccessful. The authors believe that the best results were achieved by cyst removal with resection of cerebral structures being the source of epileptic discharges under intraoperative electrocorticographic control. The regression or diminished intensity of seizures can be achieved in this way. The fenestration of cyst alone leads to cyst recurrence. Cyst-peritoneal shunting usually did not lead to significant reduction of cyst size and delayed complications caused this kind of treatment to be uneffective. The significant number of infectious complications in all surgical treated cases of arachnoid cysts suggest the need for avoiding operation in asymptomatic or oligosymptomatic cases.

[Causes and incidence of abscesses of the brain and cerebellum in adults]. / Przyczyny i czestosc wystepowania ropni mózgu i mózdzku u doroslych.

The frequency of cerebral and cerebellar abscesses was analysed in relation to all intracranial tumours in the material of the Department of Neurosurgery, Medical Academy in Warsaw, and the causes of these abscesses in a group of 62 cases treated in the last ten years. The subject of interest was the variability of these parameters in the era of widely used antibiotic treatment. It was observed that in the last years the frequency of brain abscesses has decreased. They account presently for 2.2% of all intracranial tumours. The first place among the causes of abscesses is taken by otogenic infections with nasal sinusitis, although the percent of these causes is decreasing. Presently, the number of abscesses of unknown origin has been increasing, probably due to the widespread use of antibiotics which eradicate the primary infection focus early after its appearance.

[Conservative treatment of brain abscesses]. / Zachowawcze leczenie ropni mózgu.

The authors present 6 patients with brain abscesses treated conservatively. There were multiple brain abscesses in 4 patients. The patients were in good general condition without marked symptoms of high intracranial pressure. The conservative treatment lasted 4 to 11 weeks under CT control and careful observation of clinical status. 5 patients were cured, 4 of them without any neurological deficit and 1--with visual field defect after bilateral brain abscesses in occipital lobes. 1 patient died in spite of drainage of the biggest of multiple abscesses. The authors confirmed the value of conservative treatment in selected cases of brain abscess, specially in multiple brain abscesses. The early beginning of such treatment seems to be specially important.

[Colloid cysts of the third ventricle]. / Torbiele koloidowe trzeciej komory.

Colloid cysts of the 3rd ventricle, diagnosis and treatment. 11 patients with colloid cyst of the 3rd ventricle were diagnosed and treated at the Department of Neurosurgery the Medical University of Warsaw, between 1987 and 1996. The patients comprised 5 females and 6 males, aged 22 to 58 years. Mean time from the occurrence of the first symptoms to surgery was 23 months, although this varied in individual cases from 8 days to 10 years. In the majority of patients, the leading symptoms were: headaches, nausea, vomiting and papilloedema, comprising symptoms of high intracranial pressure. Slowly progressing symptoms of organic brain damage syndrome were observed in 5 patients. Preoperative diagnosis was based on CT of the head in 8 patients, on NMR in 2 and on both CT and NMR in 1 patient. At the first stage of treatment, a ventriculo- peritoneal Y-shunt was used in 3 patients to eliminate symptoms of high intracranial pressure. All patients then underwent radical surgery. 9 patients were treated by craniotomy in the frontal region with incision of the cortex and then through the lateral ventricle and interventricular foramen. 1 patient was operated by craniotomy and through the terminal lamina of the 3rd ventricle. In 1 case the cyst was evacuated via neuroendoscope. There were no cases of mortality among our patients. Full recovery occurred in 8 patients. In 3 patients symptoms of organic brain damage syndrome observed prior to surgery remained, but in a lesser degree, which may be a result of the correct diagnosis being established too late. In over 5 years' follow-up, no cases of recurrence were observed.

[Operations on the peripheral nervous system in the treatment of spasmodic torticollis]. / Operacje na obwodowym ukladzie nerwowym w leczeniu kurczowego kreczu karku.

The aetiopathogenesis of spasmodic torticollis has not yet been explained. The problem of surgical treatment selection is also at issue. The authors present own observations in 5 cases treated by operations on the peripheral nervous system. In 3 cases a very good therapeutic results was obtained, in 2 cases the results was not satisfactory. A characteristic fact was appearance of ultimate improvement only several months after the operation, similarly as it is observed after stereotactic operations. In the light of own observations and a survey of the literature the authors reach the conclusion that operations on the peripheral nervous system as the first stage of surgical treatment give good results in most cases.

[Destruction of Forel's field in the surgical treatment of epilepsy. Preliminary report]. / Niszczenie pola Forela w operacyjnym leczeniu padaczki. Doniesienie wstepne.

UNLABELLED: Stereoencephalotomy remains often the only therapeutic method in severe cases of drug-resistant epilepsy in which it is not possible to use the classic resection methods. In the light of literature data we chose Forel's field as the site for producing stereotaxic lesions since it is the most strategically situated site in the pathways of propagation of epileptic seizures. SURGICAL TECHNIQUE: we used Leksell's stereotaxic apparatus for the operations. The contrast medium for filling the ventricular system was Dimer X. The parameters used in accordance with Jinnnai were calculated from the intercommissural line. The clinical and electrophysiological features of these cases are reported. Eleven patients were operated upon who could not be qualified for other surgical treatment methods because of generalized EEG changes. The main criterion accepted for qualification of patients by us were frequent seizures (at least 1 daily) despite systematic treatment conducted under control of serum drug levels. The indication for selecting the side of the operation was preponderance of EEG changes or presence of any lateralizing signs in the seizures. The duration of follow-up sufficient for evaluating the effectiveness of the operation was obtained in 7 patients. The following results were achieved: very good in 1 case, good in 3, improvement in 2 and poor in 1. In the light of these preliminary observations we consider that unilateral destruction of Forel's field is an operation indicated in severe generalized seizures, especially in the primary generalized form.

[Compression of the optic nerves by arteriosclerotic internal carotid arteries. Case report]. / Ucisk nerwów wzrokowych przez tetnice szyjne wewnetrzne miazdzycowo zmienione. Opis przypadku.

The authors describe a case of a 53-year-old woman with recurrent episodes of high-grade amblyopia leading to blindness of the left eye and considerable impairment of the visual acuity of the right eye. Laboratory investigations ruled out presence of a tumour in this area. In view of possible adhesive arachnitis in the region of the chiasma exploratory craniotomy was done finding an evident compression of the visual nerves closely at the optic foramina by the dilated and atherosclerotic internal carotid arteries. The authors review the literature on the problem stressing the rarity of the syndrome.

[Clinical analysis and the results of surgical treatment of aneurysms of the vertebrobasilar system]. / Analiza kliniczna i wyniki leczenia operacyjnego chorych z tetniakami ukladu kregowo-podstawnego.

The authors present a clinical analysis of 42 patients with vertebro-basilar aneurysms considering symptoms, course and complications of subarachnoid haemorrhage and localization of aneurysms: 88% were admitted after SAH, 47.6% had basilar bifurcation aneurysm. The ischaemic deficits due to vasospasm were observed in 5.4% of cases. Rebleeding occurred in 29.7% of patients, most of them died. 23 patients were operated on. In 69.9% of cases the operation was successful. The operative mortality was 17.4%. Temporary third nerve palsy was the most often postoperative complication.

[Chronic bleeding into the syringomyelic cavity (Gower's syringal hemorrhage)]. / Przewlekle krwawienie do jamy syringomielicznej (Gowers syringal haemorrhage)

The authors describe a rare case of chronic bleeding into the syringomyelic cavity treated surgically. Bleeding caused slowly increasing manifestations of disease after 23 years of stationary phase. The cause of such bleedings is unknown.

[Stereotaxic ventroposteromedial thalamotomy in the treatment. Clinical observations and physiopathological considerations]. / Stereotaktyczna talamotomia brzuszna tylno-przysrodkowa w leczeniu bólu. Spostrzezenia kliniczne i rozwazania patofizjologiczne.

In 6 patients the authors performed stereotaxic ventroposteromedial thalamotomy for abolition or reduction of pain. The operation produced lesions in the centrum medianum and parasfascicular nucleus. In 2 cases unilateral operation was performed contralaterally to the side of pain, in the remaining cases the operation was done bilaterally as a one-step procedure. Postoperative follow demonstrated that in 1 case improvement was completely absent, in 4 initial good effect was transient and pain returned after several weeks and in only 1 patient very good effect persists for over 12 months. In the light of these experiences and a survey of the pertinent literature the authors reach the conclusion that limited stereotatic lesion of the so called non-specific pain-transmitting thalamic nuclei produces permanent abolition or alleviation of pain in few cases only. The pathophysiology of pain is discussed in the light of these data.