[Angiomas of blood vessels supplying the basal ganglia and the diencephalon]. / Naczyniaki zakresu unaczynienia jader podkorowych i miedzymózgowia

The author discusses the problem of surgical treatment of intracranial angiomas situated in basal ganglia and diencephalon. Vascular malformations in this area were found in 7.5% of cases in a group of 80 patients with intracranial angiomas. In all 6 cases the onset of the disease was sudden with meningocerebral haemorrhage, prolonged coma and hemiplegia. The malformations had usually the features of arteriovenous angioma. The afferent vessels come usually from the medial short and long vessels branching off from the anterior and middle cerebral arteries, the choroid arteries and the posterior communicating artery. The author isolated two types of malformations differing in their situation, shape and range of vascularization. In the "subventricular" type situated within the nucleus caudatus and lenticularis, internal capsule and thalamus the malformation can be exposed well from the approach through the lateral ventricle. The angiomas situated nearer to the base of hemisphere (the parabasal type), in the diencephalon, in the area of the olfactory triangle, substantia perforata anterior and even crus cerebri can be exposed best using the subfrontal approach. The author believes that in many cases of these malformations regarded usually as inoperable, radical operation can be done with selective removal of angioma by means of microsurgery. This procedure was applied in 2 cases (Fig. 2 and 3).

[Clinical assessment of the severity of craniocerebral injury]. / Kliniczna ocena stanu ciezkosci chorego po urazie czaszkowo--mózgowym.

Assessment of overall patient responsiveness (coma grading) is essential in the characterization of craniocerebral injuries and grading of their severity. The combination of psychological and anatomical scores and additional examinations has yielded patient characterization which more accurately relates to outcome than when those scores are used alone. The aim of this study was to survey the methods of craniocerebral injury evaluation in neurosurgical practice.

[Contrast ventriculography using dimer-X]. / Wentrykulografia cieniujaca przy pomocy dimeru-X.

The authors report the results of 100 Dimer-X ventriculographies mainly in cases of midline tumours. The value of tomography for the diagnosis of tumours is stressed. Besides that, the contrast was used for visulization of intracerebral cavities, emptied abscesses, cavities in astrocytomas and intracerebral haematoma. Complications following the use of Dimer-X for direct filling of the ventricular system are discussed.

[Aneurysm situated within the optic nerve]. / Tetniak umiejscowiony wewnatrz nerwu wzrokowego

A case of carotid-ophthalmic aneurysm of unusual location in the optic nerve is reported. The development of the disease was sudden: pain in the eye was followed by unilaternal blindness and manifestations of subarachnoid haemorrhage. The optic nerve was dilated balloon-like, cyanotic and vigorously pulsating. It was divided longitudinally and the aneurysmatic sac was exposed from the nerve. A vascular clip was put on its peduncle communicating with the cervico-ophthalmic portion of internal carotid artery. Despite preserved patency of the ophthalmic artery and partial continuity of the optic nerve, the vision of the eye didn't improve.

[Spontaneous subarachnoid hemorrhage in pregnancy]. / Samoistne krwawienie podpajeczynówkowe u kobiet ciezarnych.

Subarachnoid haemorrhage from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. The authors analyzed 11 cases of verified subarachnoid haemorrhage during pregnancy from 10 identified and 1 unidentified cerebral vascular malformation. The aneurysms were responsible for subarachnoid haemorrhage in 6, and arteriovenous malformation in 4 patients. We conclude that the decision to operate after subarachnoid haemorrhage during pregnancy should be based upon neurosurgical principles, whereas cesarean delivery should be done in every pregnant patient with subarachnoid haemorrhage.

[Tension measurement of pulse pressure of herniation in children]. / Tensometryczny pomiar cisnienia pulsacyjnego tetnic szyjnych.

Nine patients were operated on in Department of Neurosurgery in Poznan throughout 1990-1993 because of the insufficient carotid blood circulation. In patients measurements of the pulsation pressure of the carotid artery were carried out with a tensometric sensor of pressure during surgery. Neurological symptoms, EEG, evoked potentials and other examinations were conducted before an after operation and correlated with results of pulsation pressure.

[Aneurysmal bone cyst of the skull and vertebral column treated operatively]. / Torbiele tetniakowate czaski i kregoslupa leczone operacyjnie.

Aneurysmal bone cysts considered as a benign lesion are extremely rare in the skull or in the vertebral column. In the last 29-years were admitted to Department of Neurosurgery in Poznan 11 patients with aneurysmal bone cysts involving the skull in 4 and the spine in 7 cases. All but one patients were female, aged between 4 and 37 years. Location of skull cysts were: parietal in 1, occipital in 1, and parietotemporal in two cases. In patients with spinal affection the position of vertebral cysts were: cervical -2, dorsal -4 and lumbar -1 case. All patients suffered severe pain radiating to the adjacent area and showed local deformity of bone structure. Paraparesis or paraplegia were observed in cases with spinal involvement. In all patients, total surgical removal of the aneurysmal bone cysts was possible. Skull defect was covered with plastic materials. In the repair of the vertebral defect, pelvic bone grafts were used and fixed with wire suture. In follow-up ranging from 1 to 25 years there was no tendency for recurrence.

[Congenital carotid-sinus cervical-sagittal fistula]. / Wrodzona przetoka tetniczo-zatokowa; szyjno-strzalkowa.

The reported case presented an unusual form of congenital carotid-sagittal communication. Clinical findings included: except vascular murmur over the skull a characteristic syndrome consisting of of epleptic seizures, hemiparesis, aphasia and dementia. The communication was excised radically in its central and peripheral parts. The segment corresponding to the main trunk of the middle cerebral artery was narrowed by means of bipolar coagulation. Postoperative angiography and disappearance of most neurological signs after the operation showed that the chronically ischaemic parts of the brain resumed their functions.

[Giant cell tumors of vertebral column]. / Guz olbrzymiokomórkowy kregoslupa.

Between 1962 and 1993 were treated at the Department of Neurosurgery, Medical Academy in Poznan 11 patients (10 women and 1 man) with giant-cell tumours of the spine. Their mean age was (26.27 +/- 17.56) years. In all patients pain was the presenting symptom and 10 had neurological deficits. The cervical, thoracic and lumbo-sacral spine was involved; 9 patients were treated surgically and 3 patients received adjuvant radiotherapy. The follow-up time was from 2 months to 30 years.

[Central nervous system trauma in children. Clinical analysis of 782 cases]. / Urazy centralnego ukladu nerwowego u dzieci. Analiza kliniczna 782 przypadków.

A series of consecutive 782 children with severe head trauma and spinal cord injury who were managed surgically or conservatively in the Department of Neurosurgery, Medical Academy in Poznan during 31 years was analysed. The clinical history, severity of injury (scales AIS, ISS), outcome of head and spinal cord injuries are reviewed. Factors important in predicting a poor outcome included the presence of brainstem contusion, intracranial haematomas and complete and severe partial spinal cord lesions.

[Factors contributing to recurrence of intracranial meningiomas and indications to postoperative radiotherapy]. / Czynniki sprzyjajace odrostowi oponiaków wewnatrzczaskowych i wskazania do pooperacyjnej radioterapii.

The incidence of various histological subtypes of intracranial meningiomas and recurrences was examined in 565 patients with surgically treated meningiomas in the Department of Neurosurgery in Poznan, between 1960-1992. Approximately 60% of the tumours were located on the convexity (39.5%) and parasagitally (23%). Histological diagnosis in 88% of the patients was endotheliomatous (61%), fibroblastic (17%) and angiomatous (10%) meningiomas. The incidence of recurrence after complete removal of the meningioma was 7% for all sites, but much higher after partial removal. Among the recurrences, there was a higher degree of malignant and angiomatous subtypes. Surgery is the accepted form of treatment for meningiomas but it may prove insufficient as the only method of therapy in certain situations. Implications for the potential role of postoperative radiation therapy are discussed.

[The management of subarachnoid hemorrhage in pregnancy]. / Postepowanie w samoistnym krwotoku podpajeczynókowym w okresie ciazy.

Subarachnoid haemorrhage (SAH) from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. Authors critically analyzed 12 cases of verified SAH during pregnancy from an 11 identified and 1 unidentified cerebral vascular malformation. Aneurysms were responsible for SAH in 7, and arteriovenous malformations in 4 patients. Subarachnoid haemorrhage occurred during I trimester in 2, II trimester in 3, III trimester in 6 patients and after cesarean delivery in 1 case. We conclude that the decision to operate after SAH during pregnancy should be based upon neurosurgical principles, whereas the cesarean delivery should be done in every pregnant patient with SAH.

[Surgical management of pituitary adenomas by transsphenoidal approach]. / Chirurgiczne leczenie gruczolaków przysadki mózgowej z dojscia przez zatoke klinowa.

In the years 1976-1993 we have performed 90 transsphenoidal approaches for pituitary adenomas. This paper presents a detail report concerning 23 cases, operated in the last 2 years, with CT and NMR documentation. A preoperative visual deficit was very common in this group of patients. In the postoperative period the dramatic improvement of the vision was observed in 86% of cases. In our opinion the transphenoidal approach is very useful for the operation of the tumors with suprasellar expansion.