Trigone ventricular meningiomas - clinical characteristics, histopathology and results of surgical treatment.

AIM OF THE STUDY: Intraventricular meningiomas (IVMs) are rare tumours accounting for 0.5-3.0% of all meningiomas. IVMs require different surgical approaches and preparation in deep brain areas. The aim of our study was to present the clinico- -histopathological characteristics and treatment outcomes of trigone IVMs in a series of 15 patients. MATERIALS AND METHODS: Eight women and seven men (mean age 52) with 15 trigone IVMs were retrospectively analysed. Patients presented with headache (47%), psychoorganic syndrome (40%), hemianopsia (33%) or paresis (20%), including three (20%) patients with Karnofsky Performance Scale (KPS) < 80. Mean tumour size was 55.2 mm (range: 30-100 mm). RESULTS: Gross total tumour resection was performed in 14 (93%) cases, and subtotal in one (7%). A new deficit appeared in 83% (5/6) following a transparietal approach, in 14% (1/7) following a transtemporal approach, and in none of two patients following a transoccipital approach. Postoperative complications occurred in six (40%) patients; no patient died, but in two (13%) the new deficit was permanent. Tumour re-growth was found in two (13%) patients after 14 and 31 months. Meningiomas of WHO grade I occurred in 12, grade II in three, and grade III in one tumour recurrence. In long-term follow-up (mean: 60.8 months), including the results of revision operations, KPS: 80-100 was in 13 (87%) patients, KPS: 50 in one (severe hemiparesis after revision) and one patient was lost to follow-up (KPS: 100 on discharge). CONCLUSIONS: 20% of IVMs in our series were atypical. The results of surgery for IVMs, although satisfactory in general, require further improvement by reducing the rate of focal deficits resulting from a surgical approach.

Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors.

BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas (SDAVFs) are rare, acquired pathology and they inevitably lead to severe disability if untreated. The aim of this study is to present the outcome and complications, and to find factors that may affect the outcome after surgical treatment. METHODS: Seventeen consecutive patients (men - 14, women - 3, age: 41-79) were retrospectively analyzed. The patients presented with paraparesis (88%), bladder symptoms (71%) and/or sensory disturbances (65%). The fistula was found in the upper thoracic spine in 2 cases, in the lower thoracic (T7-Th12) in 11 cases, and in the lumbar spine in 4 cases. Microsurgical shunt interruption was performed in all, followed by epidural arteries coagulation in 12 cases. RESULTS: In the long term, improvement or achievement of a good stable condition was observed in 13 patients (76%), and no patient deteriorated. All 5 paraplegic patients improved by at least 1 grade in MCS. Satisfactory results (modified McCormick Scale grades I-II) were found in 10 patients (59%), and 15(88%) were independent. Postoperative complications occurred in 4 patients (24%), two of them (12%) required revision surgery for epidural hematoma. The success rate was 94%; one patient required revision surgery for recurrent SDAVF. Better neurological condition on admission (p=0.0098) and age >60 years (p=0.0498) were the factors associated with satisfactory outcome. CONCLUSIONS: Microsurgical closing of a SDAVF brings good and stable results over time. Aggressive treatment should be attempted even in cases of total loss of spinal cord function. Neurological condition before surgery and age may influence the outcome.

Flow-diverting devices in the treatment of unruptured ophthalmic segment aneurysms at a mean clinical follow-up of 5 years.

A shift toward the endovascular treatment of ophthalmic segment aneurysms is noticeable. However, it is not clear if the long-term treatment results improve with the development of endovascular methods. The aim of this study was to present the outcomes of the treatment of unruptured ophthalmic aneurysms using flow diverting devices (FDD) with or without coiling. This retrospective study included 52 patients with 65 UIAs treated in 2009-2016. The mean aneurysm size was 8.8 mm. Eight aneurysms were symptomatic. Therapeutic procedures included: 5 failed attempts, 55 first sessions with FDD deployment (bilateral procedures in 3) and 3 retreatment procedures. To cover 55 ICAs, 25 Silk, 26 Pipeline, 9 Fred and 1 Surpass FDD were used. FDD with coiling was applied in 19(29.2%), mainly for symptomatic and larger aneurysms. Mean radiological and clinical follow-up was 12 and 61 months, respectively. Postprocedural deterioration was noted in 3(5.8%) patients, but in long-term the modified Rankin Scale grades 0-2 were achieved in 98.1% of patients. One patient died from the treated aneurysm rupture (annual risk-0.07%). Raymond-Roy occlusion classification class I or II was achieved in 98.5% in the long term, with similar results in both groups. Complications occurred in 40.4% of patients and the most frequent were: imperfect FDD deployment (15%), failed attempt of FDD deployment (9.6%) and late FDD stenosis (9.6%). Flow-diverting devices, with additional coiling in selected cases, may offer a very high proportion of satisfactory outcomes. However, in our experience the high risk of complications remains.

An Assesment of Usefulness of Smartphone as a Magnifying Device for Microsurgery Training.

BACKGROUND: Currently available smartphones are equipped with optic systems allowing even 10x magnifi-ca-tion, which makes it possible to use them as magnifying devices for microsurgery training. The objective of this study was to assess the usefulness of smartphones for basic microsurgery training. MATERIAL AND METHODS: Two students began experimental microsurgical training using a smartphone as a magni-fy-ing device. Both students had acquired microsurgical skills following training under the microscope. For the expe-riment, the time of completion of a "6 stitches" test was measured and compared for each student using a smartphone and a microscope, after 1 and 6 hours of training using only a smartphone. RESULTS: After one hour of training, the first student completed the "6 stitches" test within 7:52 min. under the mi-croscope and within 16:35 min. using a smartphone, while the respective scores of the second student were 12:31 and 20:12 min.. In both cases the time required to complete the test was longer when working with a smartphone. The test was repeated after 6 hours of practice with a telephone, and the results now were as follows: first student 7:10 min. with the microscope and 12:50 min. with a smartphone, second student 8:54 min. with the microscope and 12:01 min. with a smartphone. CONCLUSIONS: 1. The microsurgical skills of both trainees improved gradually when they were using a smartphone (by 3:8 min. and 8:1 min) and the microscope (by 0:4 min. and 3:8 min). 2. Two drawbacks of the smartphone were noticed: lack of three-dimensional vision, deteriorating vertical orientation in the operating field and worse vision quality compared to the microscope. 3. Advantages of this tool include the availability of training at home, low cost and possibility of analysis of images recorded in the smartphone memory.