Primary balloon cell malignant melanoma of the right temporo-parietal region arising from meningeal naevus.

An unusual case of primary balloon cell malignant melanoma (BCMM) in brain arising from melanoblastic meningeal (or diffuse meningeal) naevus in a 30-year-old woman has been presented. The characteristic balloon cells were amelanotic or focally extremely weakly melanotic. The large, uniformly looking, tightly packed, pale "balloon cells" formed the homomorphic texture of the spherical well demarcated tumor lying in the white matter of right temporo-parietal region beneath the nevoid-looking partially melanotic diffuse meningeal and cortical infiltrate. Positive melanoma antigen HMB-45, S-100 protein and vimentin along with negative epithelial membrane antigen EMA and markers for macrophages like alfa-1-antitrypsine and CD-68 proved that balloon cells belong to and may form a peculiar type of melanoma. The lack of suspected skin or mucosal naevi and coexisting meningeal naevus speak for the primary character of the balloon cell melanoma. According to our knowledge it is the first primary balloon cell melanoma of the brain. Differential diagnosis and the pathogenesis are discussed.

[Significance of CT in the assessment of risk due to cerebral vasospasm following subarachnoid hemorrhage]. / Wartosc tomografii komputerowej w ocenie zagrozenia skurczami naczyn mózgowych po krwotoku podpajeczynówkowym.

The relationship between the amount and localization of blood in the subarachnoid space and the occurrence of vasospasms was studied in 100 patients with aneurysmal subarachnoid haemorrhage with cerebral vasospasm as complication. In the control group comprised 100 patients in whom angiography revealed no vasospasm. Within one week of subarachnoid haemorrhage all patients underwent computerized tomography of the head. The examination was initially conducted without and subsequently with the administration of contrast medium in a 2 mm thick layer. The amount and distribution of blood were evaluated according to Fisher scale. Follow-up cerebral angiography was performed in most cases in the second week after haemorrhage. In the studied group the occurrence of blood in the subarachnoid space was disclosed in 71 (71%) of the patients. In most cases it was present as clots in basal cisterns. In the control group the presence of blood was found in 32 (32%) of patients, this being usually diffused in subarachnoid space. The results obtained, as well as those quoted from other works, confirm the usefulness of computerized tomography in prognosing the risk of cerebral vasospasms following subarachnoid haemorrhage. However, the method is not to be overestimated.

[Thrombosis of the cavernous sinus]. / Zakrzep zatoki jamistej.

The authors describe a case of cavernous sinus thrombosis in a female aged 59 years referred to hospital with suspected tumour at the base of the brain. With the present broad use of sulphamides and antibiotics the incidence of septic thrombosis of the cavernous sinus has decreased considerably. In the reported case the infectious focus giving rise to the thrombosis was in the palatine tonsils or in teeth with gangrenous changes. The thrombosis was associated with infarction of the left hemisphere. The correct diagnosis was established after CT of the head.

[Clinical-radiological correlations of cerebral vasospasm and cerebral infarction in patients after subarachnoid hemorrhage]. / Korelacje kliniczno-radiologiczne skurczu naczyn mózgowych i zawalu mózgu u chorych po krwotoku podpajeczynówkowym.

The correlation was studied between angiographically demonstrated vasospasm, ischaemic focus demonstrated by computed tomography and the clinical condition in 100 patients within 2 weeks after spontaneous subarachnoid haemorrhage. The control group comprised 50 patients after subarachnoid haemorrhage without vasospasm. The clinical condition of the patients with vasospasm was more serious than in the control group. The proportion of patients with clinical grade I was 24% in the group of vasospasm and 50% in the control group. Ischaemic foci were found in computed tomograms four times as frequently in the group with vasospasm than in the control group. Neurological deficit was noted in 41% of patients with vasospasm and in 26% in the control group. The study confirmed correlations between vasospasm, cerebral infarction and neurological deficit but these correlations were not strong.

[Risk factors for surgical treatment of supratentorial cerebral arterio-venous angiomas]. / Czynniki ryzyka w leczeniu chirurgicznym nadnamiotowych naczyniaków tetniczo-zylnych mózgu.

The authors present the influence of the selected risk factors in surgical treatment of supratentorial cerebral arterio-venous angiomas. The material represents 38 patients treated in the Neurosurgical Department Collegium Medicum of the Jagiellonian University in the last decade. In 28 of the patients the first sign of angioma was subarachnoid haemorrhage (SAH) and the remaining 10 were revealed with seizures. The assessment of the patients when admitted to the Department was graded using the WFNS scale. The diagnosis was established based on clinical symptoms, the results of computerized tomography and cerebral angiography. The extent of the SAH was graded by the Fisher's scale. The detected angiomas were classified according to the Spetzler scale. All patients were operated on using the microsurgical technique. After occluding the feeding arteries, a selective excision was made into the angiomas and the pathological cerebral tissue. The radical of the operation was controlled by cerebral angiography. The results of the surgical treatment were graded by the modified "outcome" Spetzler scale. The following risk factors were analysed: age, WFNS grade, Fisher's grade and Spetzler's grade. The statistical calculations were made using the chi square test and the Mann-Whitney U-test (p < 0.05). In 7 of the patients the results were very good (18.4%), in 12 the results were good (31.6%), and in 14 the results were bad (36.8%). Five of the patients died (13.2%). There was no statistically significant relationship between the risk factors and the results of treatment of supratentorial cerebral arterio-venous angiomas. In the percentage analysis, the best results were obtained from young patients without SAH and with superficial pattern of venous drainage.

[Current diagnostic methods in normotensive hydrocephalus]. / Wspólczesne metody diagnostyki wodoglowia normotensyjnego.

Based on literature of the last 30 years we present the current view concerning diagnosis of the communicating hydrocephalus. Till now various methods of the assessment of hydrocephalus have been used in order to select patients for shunt treatment. No single factor, considered apart from the other diagnostic criteria, is sufficient to undertake the decision of shunting. According to current opinion the lumbar infusion test is the most valuable in the assessment of hydrocephalus, supporting us with the data of pressure-volume relations in patient. Based on our own experience the infusion test is not only useful in the preoperative investigation, but also for the assessment of proper shunt function.

[Intradural clivus chordoma: surgical treatment with no tumor regrowth 12 years after surgery]. / Wewnatrztwardówkowy struniak stoku: leczenie operacyjne z 12 letnim okresem bez wznowy guza.

We present a case of a 19-year-old woman treated in the Neurosurgery Department of Collegium Medicum of the Jagiellonian University in Kraków because of the clival chordoma. The patient with one year anamnesis, treated surgically and then rehabilitated, was examined 12 years after she left our department. Radiologically we did not find tumor regrowth. We only found diplopia, but this sign was present from the time of the operation. Such a long time of katamnesis proves possibility of total removal in this type of tumors.

[Chordomas. Analysis of 24 cases]. / Struniaki. Analiza 24 przypadków.

Chordoma is a relatively rare neoplasm originating from the remnants of the embryonic notochord. We analysed 24 cases of chordoma. The patients were divided into groups depending on the localisation. We analysed the results of different methods of therapy: surgical treatment, radiation therapy and combined surgical and radiological treatment. The results were compared with the data from the references.

[Immediate and late results of surgical treatment of hydrocephalus after subarachnoid hemorrhage]. / Bezposrednie i odlegle wyniki leczenia operacyjnego wodoglowia po krwotoku podpajeczynówkowym.

During the period from January 1st 1983 up to the end of April 1989 in the Neurology Department and the Neurosurgery Department 1417 patients were treated due to subarachnoidal hemorrhage. Among these patients in 275 cases the inner hydrocephalus was diagnosed using computer tomography (19.4%). In 17 cases (6.2%) hydrocephalus was treated surgically. In all patients the ventricle-atrial Pudenz valve was implanted; in 15 patients the valve was implanted for low pressure and in 2 for moderate pressure. The diagnostics was based on the computed tomography and angiography of cerebral vessels. In all cases large hydrocephalus was diagnosed (the anterior horn index in the computed tomography was below 3.0). The most frequent clinical symptoms were: urine incontinence (15 cases), disturbances of orientation (8 cases), akinetic mutism (8 cases) and paresis of extremities (7 cases). Above symptoms together with radiologic image presented indication for the valve implantation. Very good and good results were obtained in 13 patients, bad results in 2 cases, 2 patients died. Longer observation showed that 6 patients remain in satisfactory state, 3 patients are in bad state and 3 others died.