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Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Plzensky Lekarsky Sbornik is the property of Charles University Prague, Karolinum Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Radiation necrosis in eloquent areas of the central nervous system (CNS) is one of the most serious forms of toxicity from radiation therapy. The occurrence of radiation necrosis in the CNS is described in a wide range of 3 months to 13 years after radiation therapy. The incidence of this complication covers a wide range of 3-47%. The potential advantage of proton therapy is the ability to reduce dose to normal tissue and escalate tumor dose. Proton beams enter and pass through the tissue with minimal dose deposition until they reach the end of their paths, where the peak of dose, known as the Bragg peak, occurs. Thereafter, a steep dose fall-off is evident. Such a precisely-distributed dose should reduce the toxicity of the treatment., Patient: A 23 year-old female patient underwent radical microsurgical resection of anaplastic ependymoma that originated from the floor of the fourth ventricle. The tumor was growing into the foramen magnum dorsally from the medulla oblongata. Taking into account the age of the patient, the localization of the tumor and the required dose of 60 Gy, proton therapy was chosen due to the lower risk of damage to the brain stem. Radiation therapy was performed using pencil beam scanning and one dorsal field. Following this course of treatment, radiation necrosis of the medulla oblongata and the upper cervical spinal cord occurred with fatal clinical impact on the patient. The article analyses possible causes of this complication and a review of the current literature is given., Conclusion: Despite the theoretical advantages of proton therapy, no clinical benefit in CNS tumors has yet been proven in comparison with modern methods of photon therapy. Proton therapy is accompanied by many uncertainties which can cause unpredictable complications, such as radiation necrosis at the edges of the target volume. Following proton therapy, there is not only a higher incidence of radiation necrosis but it occurs both sooner and to a higher degree. In cases of high anatomical complexity, the neurosurgeon should cooperate in the creation of the radiation treatment planning to ensure its optimization.Key words: brain tumors - ependymoma - radiation therapy - proton therapy - necrosis - radiation necrosis This work was partially supported by research project MH CZ - DRO (Faculty Hospital in Pilsen - FNPl, 00669806). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 29. 6. 2017Accepted: 25. 7. 2017.

The authors present the technical aspects of perioperative safety during the microsurgery of cerebral aneurysms. We evaluated the advantages and disadvantages of the microvascular Doppler ultrasonography, the intraoperative digital subtraction angiography, the intraoperative transit time flowmetry, the intraoperative monitoring - motor evoked potentials and somatosensory evoked potentials, and the ICG videoangiography. The authors, based on their own experience, recommend combining different methods to eliminate the weak points of the individual specific methods. Combining the ICG with the flowmetry and the motor evoked potentials enhances safety during the surgery of cerebral aneurysms with the resultant reduction of the perioperative morbidity/mortality.

Background: The Non- Hodgkin-lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience., Patients and Methods: Retrospective analysis of patients with NHL brain infiltration dia-gnosed in 2001- 2011 at our university hospital., Results: Twenty -seven patients with median age of 61 (range 42- 82) years were analyzed. The primary diffuse large cell B cell lymphoma of CNS was defined in 22/ 27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Ki 67 was 80%, the number of NHL lesions 1 (1- 8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2- 45) months., Conclusion: The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.

Cerebral aneurysms occur in 5% of the adult population. Their most severe clinical manifestation is subarachnoid haemorrhage occurring in half of the patients. Morbidity and mortality of subarachnoid hemorrhage is relatively high. Stopping blood flow into the aneurysmal sac is the treatment objective. The basic techniques to achieve this are closing the aneurysmal neck with a clip - clipping - and the induction of intraaneurysmal thrombosis using platinum coils - coiling. Fusiform and giant aneurysms represent a technical challenge. The solution for indicated cases is the occlusion of the magistral artery along with a high-flow bypass. A new option is the use of special stents - flow-diverters - in unruptured aneurysms. The authors present the current view on the treatment of both ruptured and unruptured aneurysms. At the same time the authors focus on factors that influence the application of up-to-date knowledge on everyday activities in their departments.