Impact of COVID-19 on neurotrauma cases, mortality rates, and rebound effect: a monocenter retrospective study.

Background and purpose:

We retro­spec­tively studied the development of neuro­trauma case numbers during the COVID-19 pandemic in the largest trauma center in Hun­gary and compared them to the data of the previous year. We hypothesized that the decrease in the number of neurotrauma cases during the restrictions would sub­sequently lead to a significant increase in a so-called rebound phenomenon. Our goal was to better understand the effect of the pandemic and the restrictive measures on neurotrauma admissions to help better pre­pare for a new pandemic or for other mobility restrictions. 

We compiled daily case numbers from January 1, 2019, to April 30, 2021, which included the treatment of 861 patients with spinal trauma and 1244 patients with head injuries from 2019 to 2020, and 871 and 1255 patients with spinal trauma and head injuries, respectively, from March 2020 to April 30, 2021. The parameters studied were patients’ age, admission date and time from injury to admission. We also conducted a minimum 3-month follow-up study with pa­tients admitted during the pandemic to determine the changes in the hazard ratio of mortality. 

We found that in each wave of the pandemic, during the restrictive measures, neurotrauma case numbers decreased. After the first restrictions, we observed a clinically relevant rebound effect among spinal trauma patients. The main findings of the follow-up were that the hazard ratio of mortality for COVID-19 infected patients was 2.5 (p < 0.001), compared with the mortality hazard ratio of COVID-19-negative patients.

Restrictions during the pandemic significantly reduced population mobility helping slow down the spread of the virus and give time to healthcare systems to better prepare. At the same time, it also reduced the number of new neurotrauma cases. In case of spinal trauma patients, a rebound effect was observed after the restrictions, which may be due to increased mobility, activity and travel. The restrictive measures reduced trauma cases effectively, while not increased the time from injury to admission. 

Surgery for craniovertebral junction pathologies: minimally invasive anterior submandibular retropharyngeal key-hole approach.

BACKGROUND: Our objective was to develop a new, minimally invasive surgical technique for the resolution of craniovertebral junction pathologies, which can eliminate the complications of the previous methods, like liquor-leakage, velopharyngeal insufficiency and wound-dehiscence associated with the transoral or lateral approaches. METHODS: During the first stage of the operation, three patients underwent occipito-cervical dorsal fusion, while the fourth patient received C1-C2 fusion according to Harms. C1-C2 decompressive laminectomy was performed in all four cases. Ventral C1-C2 decompression with microscope assisted minimally invasive anterior submandibular retropharyngeal key-hole approach (MIS ASR) method was performed in the second stage. The MIS ASR-similarly to the traditional anterior retropharyngeal surgery-preserves the hard and soft palates, yet can be performed through a 25 mm wide incision with the use of only one retractor. RESULTS: The MIS ASR approach was a success in all four cases, there were no intra- and postoperative complications. This method, compared to the transoral approach, provided on average 23% (4.56 cm2/6.05 cm2) smaller dural decompression area; nonetheless, the entire pathology could be removed in all cases. After the surgery, all patients have shown significant neurological improvement. CONCLUSION: Based on the outcome of these four cases we think that the MIS ASR approach is a safe alternative to the traditional methods while improving patient safety by reducing the risk of complications.

Treatment of Ankylosing Spondylitis Patients with Cervical Spinal Injury with Anterior Single-Stage Fixation with Bone Cement Augmentation.

Background/Objectives: Cervical spine fractures in ankylosing spondylitis (AS) are characterized as highly unstable fractures posing an elevated risk of neurological deficit and a significantly elevated mortality rate. This study assesses the efficacy and safety of single-stage plate stabilization with ventral cement augmentation in treating subaxial cervical spine fractures in patients with AS. Methods: Over 86 months, 38 patients diagnosed with AS received ventral plate stabilization with cement augmentation after suffering unstable subaxial cervical fractures. No additional dorsal stabilization was used in any of these surgeries. Results: There were no complications as a result of cement leakage. During the follow-up period, screw loosening and implant displacement were documented in two out of 38 cases. At the time of data analysis, 17 patients who had undergone treatment had died, representing 44.7% of the total cases. Seven patients died within 1 month, two patients died within 6 months, four patients died within 1 year, and four patients died after 1 year. Conclusions: Our study shows that a single-stage anterior screw and plate fixation of the cervical spine with cement augmentation could be a feasible and effective method to treat cervical spine fractures in patients with AS.

From Detection to Decision: How STIR Sequence MRI Influences Treatment Strategies for Osteoporotic Vertebral Fractures.

Background/Objectives: Osteoporotic vertebral fractures (OVFs) significantly impair quality of life. This study evaluates the impact of STIR sequence MR imaging on clinical decision-making for treating OVFs, mainly focusing on how MRI findings influence treatment modifications compared to those based solely on CT scans. Methods: This retrospective analysis reviewed cases from the Manninger Jeno National Traumatology Institute over ten years, where patients with suspected OVFs underwent CT and STIR sequence MR imaging. The study examined changes in treatment plans initiated by MRI findings. The diagnostic effectiveness of MRI was compared against CT in terms of sensitivity, specificity, and the ability to influence clinical treatment paths. Results: MRI detected 1.65 times more fractures than CT scans. MRI influenced treatment adjustments in 67% of cases, leading to significant changes from conservative-conservative, conservative-surgery, and surgery-surgery based on fracture characterizations provided by MRI. Conclusions: This study demonstrates that integrating STIR sequence MR imaging into the diagnostic pathway for OVFs significantly enhances the accuracy of fracture detection and profoundly impacts treatment decisions. The ability of MRI to reveal specific fracture features that are not detectable by CT scans supports its importance in the clinical evaluation of OVFs, suggesting that MRI should be incorporated more into diagnostic protocols to improve patient management and outcomes. The findings advocate for further research to establish STIR MRI as a standard osteoporosis management tool and explore its long-term benefits in preventing secondary fractures.

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review.

Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.

Percutaneous Superimposed O-Arm-MRI-Navigated Biopsy for Spinal Column Pathologies.

Classifying spinal tumors can be challenging due to nonspecific clinical and radiological qualities, and a precise biopsy is crucial for an accurate diagnosis and treatment planning. This study aimed to enhance the accuracy and efficiency of spinal biopsies integrating Cone Beam Computed Tomography (CBCT) and magnetic resonance imaging (MRI) modalities using an O-arm CT navigation system. Eighteen patients with different spinal lesions underwent 18 biopsies following the Stealth Station navigation system Spine 8 protocol. Preoperative MRI scans were merged with intraoperative CT navigation systems for continuous monitoring during the biopsy process. The combined imaging technique accurately identified the diseased lesion type in all biopsies, demonstrating 100% sensitivity and specificity. In conclusion, combining MRI and CT imaging modalities significantly improved spinal biopsy accuracy and efficiency, differentiating between pathological entities. However, large-scale studies are desired to validate these findings and investigate potential benefits in different clinical scenarios. Although this method requires general anesthesia, its potential profits in avoiding misdiagnosed lesions and decreasing the need for further invasive procedures make it a promising approach for improving spinal biopsy accuracy and efficiency.

Enhanced Precision and Safety in Thermal Ablation: O-Arm Cone Beam Computed Tomography with Magnetic Resonance Imaging Fusion for Spinal Column Tumor Targeting.

Spinal metastatic tumors are common and often cause debilitating symptoms. Image-guided percutaneous thermal ablation (IPTA) has gained significant recognition in managing spinal column tumors due to its exceptional precision and effectiveness. Conventional guidance modalities, including computed tomography, fluoroscopy, and ultrasound, have been important in targeting spinal column tumors while minimizing harm to adjacent critical structures. This study presents a novel approach utilizing a fusion of cone beam computed tomography with magnetic resonance imaging to guide percutaneous thermal ablation for four patients with secondary spinal column tumors. The visual analog scale (VAS) evaluated the procedure effectiveness during an 18-month follow-up. Percutaneous vertebroplasty was performed in two cases, and a thermostat was used during all procedures. Imaging was performed using the Stealth Station navigation system Spine 8 (SSS8) and a 1.5T MRI machine. The fusion of CBCT with MRI allowed for precise tumor localization and guidance for thermal ablation. Initial results indicate successful tumor ablation and symptom reduction, emphasizing the potential of CBCT-MRI fusion in spinal column tumor management. This innovative approach is promising in optimizing therapy for secondary spinal column tumors. Further studies are necessary to validate its efficacy and applicability.

Microscope-assisted odontoid resection via submandibular retropharyngeal "key-hole" approach / Fognyúlvány mikroszkóppal asszisztált reszekciója submandibularis retropharyngealis "key-hole" behatolásból

Our objective is to propose a novel surgical technique, the microscope-assisted odontoid resection via submandibular retropharyngeal "key-hole" approach. The patient suffered a traumatic cervical spine injury due to a motorcycle accident. We removed the upper two-thirds of the CII vertebra's odontoid process along with the cortical fragment causing the medullar compression. With this surgical technique the velopharyngeal insufficiency, occurring at the traditional transoral surgery, is avoidable while the access to the odontoid process is insured. The MRI confirmed ventral injury to the meninges, which increases the risk of wound healing complications and sepsis so along with the high risk of velopharyngeal insufficiency occurring at the transoral surgery, stood in favour of the new method. During the submandibular "key-hole" technique besides the use of tissue-glue, tamponing the meninges damage with multiple layers of viable soft tissue could be performed. The postoperative CT and MR imaging confirmed the complete decompression of the medulla oblongata. The patient's tetraplegic state entirely regressed, and eight months after the surgery he became self-sufficient. From now on, the surgical method we used could be a considerable alternative to the classic transoral transpharyngeal or endoscopic endonasal odontoid resection. Orv Hetil. 2020; 161(31): 1302-1306.

Prediction of volumetric change in the "triple ring" caused by glioma I-125 brachytherapy.

The aim of this study was to reveal the volumetric changes in tumor necrosis, reactive zone, and edema referred to as the "triple ring" appearing after low-dose-rate iodine-125 (I-125) interstitial irradiation of 20 inoperable low-grade gliomas. To enable prediction of these volumetric changes, we provide mathematical expressions that describe the dynamics of the triple ring. Volumes of the three regions on image-fused control CT/MR images were measured for a 24-month period. The delivered dose on the tumor surface was 50-60 Gy. Dose planning and image fusion were performed with Brain-Lab Target 1.19 software; mathematical and statistical computations were carried out with Matlab numeric computation and visualization software. To determine the volumes, control images with the triple rings were fused with the planning images. Relative volumes normalized with respect to the volume of reference dose were calculated and plotted in the time domain. First, the mean values of volumes were determined from the patients' measured data; then, polynomials were fitted to the mean values using the polynomial curve-fitting method. The accuracy of our results was verified by correlating the predicted data with the measured ones. The polynomial prediction approach proposed here reveals the dynamics of the triple ring. These polynomials will assist with (1) designing the best treatment, (2) following the patient's condition, and (3) planning reirradiation if necessary.

[Chronologic dynamics of the "triple ring," caused by interstitial Iodine-125 brachytherapy with a novel method of image fusion]. / A szövetközi 125-jód-brachytherapia következményeként kialakuló "hármas gyûrû" idôbeli változása, dinamikája új, polinomillesztésen alapuló módszerrel.

OBJECTIVE: The aim of this study is to reveal the volumetric changes in tumor necrosis, reactive zone and edema following low-dose rate 1-125 interstitial irradiation of 20 inoperable (partially non-resectable, partially inoperable) low-grade gliomas. METHODS: The volumes of the three regions on image-fused control CT/MRI images were measured for a 24-month period with 36 occasions. The delivered dose on the tumor surface (GTV) was 50-60 Gy. Dose planning and image fusion were performed with the BrainLab Target 1.19 software, mathematical and statistical computations were carried out with the Matlab Numeric Computation and Visualization software. The control images with the "triple ring" were fused with the planning images, and the isodose curves were adjusted to them. RESULTS: Relative volumes normalized to volume of the reference dose were calculated and plotted in the time domain. The mean values of volumes were determined from the patients' measured data then a polynom was fitted to the mean values using the polynomial curve fitting method. The accuracy of our results were verified by statistical tools. CONCLUSIONS: The new polynomial prediction approach using image fusion analysis of the volume of tumor necrosis, reactive ring and edema caused by interstitial irradiation as a function of time provides valuable information for 1. selecting the best patient's treatment option, 2. following up patient's condition and 3. planning reirradiation or reoperation if necessary.

Image fusion analysis of volumetric changes after interstitial low-dose-rate iodine-125 irradiation of supratentorial low-grade gliomas.

The aim of this study was to compare the volumes of tumor necrosis, reactive zone and edema with the three-dimensional dose distributions after brachytherapy treatments of gliomas. The investigation was performed an average of 14.2 months after low-dose-rate (125)I interstitial irradiation of 25 inoperable low-grade gliomas. The prescribed dose was 50-60 Gy to the tumor surface. Dose planning and image fusion were performed with the BrainLab-Target 1.19 software. In the CT/ MRI images, the "triple ring" (tumor necrosis, reactive ring and edema) developing after the interstitial irradiation of the brain tumors was examined. The images with the triple ring were fused with the planning images, and the isodose curves were superimposed on them. The volumes of the three regions were measured. The average dose at the necrosis border was determined from the isodose distribution. For quantitative assessment of the dose distributions, the dose nonuniformity ratio (DNR), homogeneity index (HI), coverage index (CI) and conformal index (COIN) were calculated. The relative volumes of the different parts of the triple ring after the interstitial irradiation compared to the reference dose volume were the following: necrosis, 40.9%, reactive zone, 47.1%, and edema, 367%. The tumor necrosis developed at 79.1 Gy on average. The average DNR, HI, CI and COIN were 0.45, 0.24, 0.94 and 0.57, respectively. The image fusion analysis of the volume of tumor necrosis, reactive ring and edema caused by interstitial irradiation and their correlation with the dose distribution provide valuable information for patient follow-up, treatment options, and effects and side effects of radio therapy.

[The possibilities of fractionated external beam repeat irradiation of relapsed primary brain tumours: the first Hungarian experience]. / Az ismételt frakcionált külso sugárkezelés (reirradiáció) elsodleges központi idegrendszeri daganatok kiújulásának kezelésére: az elsô hazai tapasztalatok.

INTRODUCTION: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques offer the opportunity to elaborate novel treatment forms, e.g. repeat irradiation techniques for primary brain tumours. AIM: The authors analysed the effect on survival and toxicity of fractionated external beam repeat irradiation in brain tumour patients. METHODS: At the National Institute of Oncology, between 2002 and 2006, fractionated external beam repeat irradiation was performed in eleven patients with recurrent primary brain tumour, with total of 50-54 Gy or near total of 34-40 Gy doses. All patients were previously treated with total radiotherapy doses of 50-64 Gy. The intervals between radiotherapy courses were in the range of 7-30 years. All the treatments were carried out with 3D image-based conformal methods, the fractionation was conventional, with 1,8-2,0 Gy daily fractions in all cases. RESULTS: The repeat irradiation was tolerated well in the material. No grade 3-4 acute toxicity was detected, and serious, grade 3 mental deterioration, not related tumour progression was observed in only one case. In one case reoperation was necessary due to histologically verified radio-necrosis with mass-effect, and we believe that late neurotoxicity caused serious functional inabilities in one case. The median progression free survival was 8 (2-33) months, the median survival was 13 (4,5-33) months. Three of our patients were alive at the end of the study. CONCLUSIONS: Based on this experience and current knowledge, in absence of other treatment possibilities, the fractionated external beam repeat irradiation with near total doses could be a therapeutic choice in case of recurrent primary brain tumours, if having appropriate background. To define the optimal treatment strategy and regimens, further clinical trials should be carried out.

Comparison of (125)I stereotactic brachytherapy and LINAC radiosurgery modalities based on physical dose distribution and radiobiological efficacy.

The goal of this study was to make a comparison between stereotactic brachytherapy implants and linear accelerator-based radiosurgery of brain tumors with respect to physical dose distributions and radiobiological efficacy. Twenty-four treatment plans made for irradiation of brain tumors with low-dose-rate (125)I brachytherapy and multiple-arc LINAC-based radiosurgery were analyzed. Using the dose-volume histograms and the linear-quadratic model, the brachytherapy doses were compared to the brachytherapy-equivalent LINAC radiosurgery doses with respect to the predicted late effects of radiation on normal brain tissue. To characterize the conformity and homogeneity of dose distributions, the conformal index, external volume index, and relative homogeneity index were calculated for each dose plan and the mean values were compared. The average tumor volume was 5.6 cm(3) (range: 0.1-19.3 cm(3)). At low doses, the calculated radiobiological late effect on normal tissue was equivalent for external-beam and brachytherapy dose delivery. For brachytherapy at doses greater than 30 Gy, the calculated equivalent dose to normal tissues was less than for external-beam radiosurgery. However, the dose-calculated homogeneity was better for the LINAC radiosurgery, with a mean relative homogeneity index of 0.62 compared to the calculated value of 0.19 for the brachytherapy (P=0.0002). These results are only predictions based on calculations concerning normal tissue tolerance. More data and research are needed to understand the clinical relevance of these findings.

[125-I brachytherapy of pineal parenchymal tumours in two patients and review of the literature]. / Két pinealoblastomás beteg 125-jód-brachytherapiája során nyert tapasztalatok es irodalmi áttekintés.

INTRODUCTION: Pineal parenchymal tumours make up 0.3% of all brain tumours. Stereotactic biopsy has by now become an indispensable method to detect these tumours and it can be safely performed. PATIENTS AND METHOD: Two patients with pineoblastoma were treated with 125I brachytherapy. The MRI and CT images taken 15 and 18 months after irradiation showed significant tumour shrinkage. RESULTS: Tumour volume was 0.76 cm3 in the control CT image in Case 1, a shrinkage by 73% compared to 2.87 cm3 measured at the time of planning the interstitial irradiation. In Case 2, tumour volume measured on the control MRI examination was 0.29 cm3 as opposed to 1.27 cm3 of original tumour volume, which represents a 77% shrinkage. CONCLUSION: The insertion of isotope seeds was performed at the same time as the biopsy, because thus the knowledge of the histological diagnosis could spare the patients from a second stereotactic intervention. The CT- and image fusion guided 125I stereotactic brachytherapy is a procedure that can be dosimetrically precisely planned and surgically accurately and safely performed.

[Volumetric changes following 125I interstitial brachytherapy of gliomas]. / Térfogatváltozások agydaganatok 125-jód-izotópos brachytherapiája után.

BACKGROUND: Image fusion permits quantitative analysis of the consequences of 125 Iodine interstitial irradiation of brain tumors. The volume of tumor necrosis, reactive zone and edema can be compared to the dosimetric data. PATIENTS AND METHOD: Nineteen patients with low grade glioma were analyzed on the average 14.5 months following 125 Iodine interstitial irradiation. Dose planning and image fusion were performed with the Target 1.19 (BrainLab) software. The CT/MR images showing the so called "triple ring" (necrosis, reactive ring and edema) developing after the interstitial irradiation of brain tumors were fused with the planning images and the isodose curves. The volume of the three regions was measured. Values at the intersections of isodose curves and necrosis borders were averaged and used for calculation of tumor necrosis. The volume of normal brain tissue irradiated by given dose values, as well as homogeneity and conformality indices were also determined. RESULTS: The relative volumes of the different parts of the "triple-ring" compared to the reference dose volume were the following: necrosis 54.9%, reactive zone 59.7%, and edema 445.3%. Tumor necrosis developed at 71.9 Gy dose. At the irradiation of an average size glioma with a volume of 12.7 cm3, 5 to 7 cm3 normal brain tissue around the tumor received 60-70 Gy dose. The average homogeneity and conformality indices were 0.24 and 0.57, respectively. CONCLUSION: The analysis of changes in the volume of edema, reactive ring and necrosis caused by interstitial irradiation, and their correlation with the dosimetric data using the image fusion method provide useful information for patient follow-up, clinical management and further therapeutic decisions.

The importance of postoperative CT image fusion verification of stereotactic interstitial irradiation for brain tumors.

PURPOSE: The aim of our study was verification of the position of implanted catheters with (125)I seeds after the catheter implantation for the brachytherapy of brain tumors. METHODS AND MATERIALS: The fusion of the CT image used at planning and after the implantation of the catheters enabled us to verify the position of the catheters containing the isotopes. After this, the tumor volume covered by the prescribed dose (TV(PD)) and the normal tissue volume covered by the prescribed dose (NTV(PD)) were compared between the plan and the actual result. The image fusion was performed by the BrainLab-Target 1.19 software on an Alfa 430 (Digital) workstation. RESULTS: The position of the catheters was adjusted in 14 (20%) of the 70 image fusion cases being studied. The position of 16 of the 116 catheters (13.8%) required adjustment after the fusion of control images in the 70 cases studied. The Student t probe revealed a significant difference between the TV(PD) values of the reality and the plans (75.8% vs. 92.4%, p < 0.0001). There was a significant difference between values of the real performances and planning for NTV(PD) (86.8% vs. 76%, p = 0.001) and for the conformity index (0.37 vs. 0.54, p = 0.0001), too. CONCLUSION: The application of the interstitial irradiation with CT control allows us to identify and correct possible inaccuracies in catheter positioning during the operation. The procedure then becomes far more accurate and reliable, and as such, the irradiation becomes more conformal than without catheter adjustment.

[Interstitial boost and altered fractionation as novel approaches to dose escalation in the radiotherapy of glioblastoma multiforme]. / A szövetközi boost besugárzás és az eltéró frakcionálás, mint új dóziseszkalációs lehetóségek a glioblastoma multiforme sugárkezelésében.

INTRODUCTION: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques give the opportunity to elaborate optimal treatment forms for primary brain tumours. PURPOSE: The authors examined the effect of two novel dose escalation methods on glioblastoma patients. METHODS: In nine cases they treated T1 tumours with single HDR-AL boost of 10-12 Gy dose following the conventional fractionated 60 Gy external beam radiotherapy. In fifteen patients with T2-4 tumours an intensified, hypofractionated regimen with 2.25-2.5 Gy daily and 60 Gy total dose was applied. All the treatments were carried out with image-based conformal methods. RESULTS: Majority of patients endured treatments without neurological deterioration. Transient neurotoxiticy was noticed in one and two cases, respectively. The median survival times (MST) were found to be 17 months (range: 9-25) and 12 months (range: 6-38) in the two groups, respectively. With respect to all patients, the MST was 13 months, while this value in the conventional treatment is generally considered to be 9-10 months. All the three patients who survived more than 18 months was treated with temozolamide chemotherapy as well. CONCLUSION: Based on own experience and current knowledge of authors, it seems reasonable to apply higher biological dose focal radiotherapy and chemotherapy in case of glioblastoma patients with better prognosis. To define the optimal treatment regimens randomised clinical trials should be executed.

[Image-fusion-guided radioisotope I-125 stereotactic brachytherapy of acoustic neurinoma--new surgical method]. / Akusztikus neurinoma kezelése képfúzió-vezérelt szövetközi 125-jód-izotóp-besugárzással--új mútéti eljárás.

Gamma knife and multi leaf collimator Linac have recently gained significant space in the treatment of acoustic neurinomas. As our neurosurgical department does not own gamma knife or Linac, we have successfully pursued the 125Iodine interstitial irradiation of three acoustic neurinomas. Our patients were elderly people with poor general condition, therefore we decided to undertake interstitial irradiation because of the low tolerance for surgery. The follow-up period until March 2002, lasted five, 23 and 40 months in the three cases. At the end of the follow-up period the audiometrical examination stated slight enhancement of hearing in case one and case two. In case one, the tumor volume, as measured on the control MRI was 5.32 cm3, which meant a 21% shrinkage in contrast to the 6.74 cm3 target volume at the brachytherapy. In case two, the shrinkage was even more apparent. The tumor volume measured on the control MRI examination was 6.64 cm3, which was a 42% shrinkage of the 11.45 cm3 target volume at the moment of brachytherapy. Due to financial reasons, gamma knife and Linac are not available for many countries and neurosurgical institutes. In the absence of the above mentioned radiosurgical methods, we have shown brachytherapy as a new alternative and solution in the treatment of acoustic neurinoma in three patients.

[Spinal stabilizations in our department (1989-2002)]. / Gerincstabilizációs mútétek osztályunkon 1989-2002.

With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilizations carried out in the Neurosurgical Department at the St. John's Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156,000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occurred in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.

[Brachytherapy of brainstem tumors]. / Agytörzsi daganatok szövetközi besugárzása.

INTRODUCTIONS: The optimal therapy of brain stem tumours of different histopathology determines the expected length of survival. Authors report 125Iodine interstitial irradiation of brain stem tumours with stereotactic brachytherapy. CASE REPORTS: Two patients having brain stem tumours were suffering from glioma or from metastases of a carcinoma. In Case 1 the tumour volume was 1.98 cm3 at the time of planning interstitial irradiation. The control MRI examination performed at 42 months post-op showed a postirradiation cyst size of 5.73 cm3 indicating 65.5% shrinkage. In Case 2 the shrinkage was more apparent as the tumour volume measured on the control MRI at 8 months post-op was only 0.16 cm3 indicating 97.4% shrinkage of the 6.05 cm3 target volume at the time of brachytherapy with the metastasis practically disappearing. Quick access to histopathological results of the stereotactic intraoperative biopsy made it possible to carry out the 125Iodine stereotactic brachytherapy immediately after the biopsy, resulting in less inconvenience for patients of a second possible intervention. The control MRI scans show significant shrinkage of tumours in both patients. CONCLUSION: The procedure can be performed as a biopsy. The CT and image fusion guided 125Iodine stereotactic brachytherapy can be well planned dosimetrically and is surgically precise.