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Objective: To examine cerebrovascular reactivity in patients after subarachnoid haemorrhage (SAH) during long-term follow-up, using Acetazolamide test and transcranial Doppler (TCD) monitoring of blood flow velocities (BFVs), to compare of CO(2) reactivity between patients after SAH treated with three different methods: surgical (clipping), endovasculary (coiling) and conservative., Methods: The study was performed in a group of 24 patients treated for SAH. Cerebrovascular reactivity (CVR) has been evaluated after intravenous administration of 1000 mg of Acetazolamide. Studied patients were divided into three groups: group I (n = 10) treated with clipping, group II (n = 8) treated with coiling and group III (n = 6)--patients with negative angiography treated conservatively., Results: Results of this study have shown that: (1) BFVs were normal in cerebral arteries and did not differ between right and left head sides, (2) CVR was normal in all studied patients, (3) method of aneurysm treatment as well as its localization had no influence on BFV and CVR, and (4) occurrence of vasospasm in early days after SAH did not result in permanent disturbances of CO(2) arterial reactivity., Conclusion: BFV values in cerebral arteries were in normal range and did not differ on the left and right head sides. CVR was normal in all examinated patients. A method of the ruptured aneurysm treatment and its localization had no influence on CBFV and CRV. Vasospasm in early period after SAH did not provoke a persistent impairment of CO(2) reactivity.

Introduction: Monitoring changes in the intracranial volume (ICV) reserve and intracranial pressure (ICP) is one of the key issues in the treatment of intracranial pathologies. The aim of this study is to develop a method of monitoring the ICV reserve by analyzing CSF volume measured using CT in specific regions., Materials and Methods: A total of 20 patients with cerebral injury were evaluated. Analysis was performed using imaging software. On selected scans (three at the basal cistern level and three at the pineal level), the following regions were analyzed: total cerebral surface (TC1, TC2) and bilateral ambient cistern (AC) only at the basal cistern level for cerebrospinal fluid (CSF) volume. Results were correlated with patients' Glasgow Coma Scale (GCS) scores., Results: An increase of CSF volume was observed with an improvement in the GCS. From the examined regions, only AC volume showed a statistically significant linear correlation (p < 0.0005) with GCS. Mean AC: 0.021, 0.454, and 0.678 mL CSF/scan in severe (3-8 pts GCS), moderate (9-12 pts GCS), and mild (13-15 pts GCS) TBI groups, respectively., Discussion: Assessment of CSF volume changes in mL CSF/scan can be conducted using CT. Counting voxels corresponding to the CSF eliminates mistakes due to inaccurate region demarcation. The obtained results (AC volume) show a high correlation with patient state.

Background and Purpose: In patients with intracerebral haematoma (ICH) secondary to ruptured aneurysm or arteriovenous malformation (AVM), conservative therapy and follow-up without angiographic evaluation is associated with a risk of recurrent bleeding. It is necessary for a clinician to identify a subgroup of patients with spontaneous supratentorial ICH who are likely to harbour high-flow vascular malformations that require specific treatment - neurosurgical or neuroradiological. A new CT-based classification for supratentorial ICH aimed at a close correlation between ICH localization and occurrence of high-flow vascular malformations diagnosed on angiography is presented., Material and Methods: According to the proposed classification, supratentorial ICHs are divided into deep and cortico-subcortical. The deep group is further subdivided into striatocapsular, lobar ICH and isolated intraventricular haemorrhage and the cortico-subcortical group into paracisternal and convexity ICH. A new classification was used in a consecutive series of 108 patients with spontaneous supratentorial ICH subjected to angiographic evaluation., Results: Deep ICH in non-hypertensive patients was secondary to AVM rupture in 57.1% (8/14). High-flow vascular malformation was a source of bleeding in 93.6% of patients with paracisternal ICH - aneurysm in most cases (41/47). Convexity ICH was found to be AVM-related in 35.7% of patients (5/14)., Conclusions: Our clinical experience shows that the proposed classification appears to be closely associated with angiographic findings. Its clinical application with consideration of other factors such as age and arterial hypertension may help clinicians to identify high-risk ICH patients for angiographic evaluation and further specific treatment to prevent rebleeding.

Surgical intervention in severe cases of occipital neuralgia should be considered if pharmacological and local nerve blocking treatment fail. The literature suggests two types of interventions: surgical decompression of the greater occipital nerve (GON) from the entrapment site, as a less invasive approach, and neurotomy of the nerve trunk, which results in ipsilateral sensation deficits in the GON innervated area of the skull. Due to anatomical variations in the division of the GON trunk, typical neurotomy above the line of the trapezius muscle aponeurosis (TMA) may not result in full recovery. The present study discusses a case of a female treated with GON decompression as a result of occipital neuralgia unresponsive to pharmacotherapy, who thereafter was qualified for two consecutive neurotomies due to severe relapse of pain.

Pilocytic astrocytoma (PA) usually occurs in younger patients. It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy. A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour. The initial symptom of the disease was epileptic seizure at the age of 16. Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed. The patient developed hydrocephalus, treated with the ventriculo-peritoneal shunt. After 5 years local recurrence of the tumour appeared in the right temporal region. The patient was operated and the tumour was totally removed. Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established. During the next years of observation increasing neurological symptoms in lower limbs developed. Subsequently, the patient reported pain syndrome in lumbosacral and perineal area. Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level. The spinal tumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour. Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma. The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period. Unfortunately, multifocal tumour involving midline structures causes major neurological symptoms and deficits. In the presented case we dealt now with the ascending spread process and the occurrence of the new foci in both subtentorial and parameningeal spaces inside the cranial cavity. It is a rare clinical manifestation of a disease ever described in the literature.

Gait and body balance disturbances are important clinical problems in patients with normal pressure hydrocephalus (NPH). They affect patients' locomotion and lead to a higher risk of falls. The gait pattern may be described as durations of the single and double support and of a stance phase. The aim of the present study was to apply the pattern recognition methods for the evaluation of gait disturbances in patients with NPH before and after neurosurgical treatment (shunt implantation). The results indicate that the parameters measured with a Computer DynoGraphy (CDG) system may effectively differentiate changes of gait in patients with NPH.

Disturbances of gait and balance are important clinical problems in patients with normal pressure hydrocephalus. A considerable degree of locomotor disability and increased risk of falls are present in many cases. Accordingly, attempts to develop effective evaluation methods of gait and balance disturbances are made. Posturography and the Computer Dyno Graphy (CDG) system appear to be useful in diagnosis and evaluation of treatment in patients with normal pressure hydrocephalus. Both are non-invasive and repeatable methods that enable accurate evaluation of analyzed parameters at time intervals.

Glial cysts of the pineal gland are benign and mostly asymptomatic incidental lesions found in the brain MRI or at autopsy examinations. In rare cases pineal cysts become symptomatic and require surgical intervention. Symptomatic glial cysts may be clinically and radiologically indistinguishable from cystic neoplasms of the pineal region; therefore, histopathological diagnosis is critical for further prognosis and therapy in operated patients. In this paper we present detailed histopathological characteristics of symptomatic glial cysts in 2 surgical cases and of asymptomatic cysts of the pineal gland found at random in 3 autopsy cases. Both surgical patients, a 19-year-old girl and a 17-year-old boy, presented with severe headaches, associated with syncope in one case and insomnia in the second one. Preoperative MR imaging suggested tumour of the pineal gland in case no. 2. Histopathological and immunohistochemical examination of the specimens from both surgical and all autopsy cases revealed a characteristic pattern of cystic structures within the pineal gland, surrounded by layers of a dense fibrillar glial tissue and pineal parenchyma, consistent with non-neoplastic glial cysts. Although histopathological findings in asymptomatic and symptomatic cysts are essentially the same, the cyst in surgical case 1 was unilocular and partly lined with ependymal cells, whereas the cysts in other cases were multilocular, comprising cavities of various size, formed in the central part of gliotic tissue or directly within the pineal parenchyma, and lacked ependymal lining. Possible pathophysiological and clinicopathological significance of some morphological variants of pineal glial cysts is discussed.

Background and Purpose: Gait disturbances resulting from the normal pressure hydrocephalus (NPH) syndrome significantly restrain locomotion, which in serious cases can lead to a total loss of the ability to move. Hence the need to create an objective method of evaluating gait disturbances described by values of gait parameters and changes of these parameters resulting from neurosurgical treatment. The aim of this project is to create an effective, non-invasive diagnostics method describing movement disorders in patients with NPH before and after surgery., Material and Methods: An evaluation of the effectiveness of gait analysis was carried out with Ultraflex, which uses the Computer Dyno Graphy (CDG) system to measure the distribution of forces of reaction on the ground during walking. The control group consisted of 17 healthy individuals (age range 50-65 years) and the treatment group included 17 patients with enlargement of the ventricular system (9 females and 8 males, mean age 58.6 years, range 50-65 years), 8 of whom were qualified for surgical treatment. Analyzed parameters: ground reaction force, single and double support, stance., Results: Changes of parameters reflected gait improvement., Conclusions: The results obtained indicate that gait analysis using the CDG system might be a good method for assessing the effectiveness of NPH surgery.

The two goals of Nonlinear Biomedical Physics are: firstly to show how nonlinear methods can shed new light on biological phenomena and medical applications and secondly to bridge the technical, mathematical, and cultural divides between the physical disciplines where these methods are being developed and the audience for their use in the biological and medical sciences.

The main consequence of subarachnoid hemorrhage, for those who survive bleeding, is delayed, persistent vasospasm of intracranial conduit arteries which occurs between the third and seventh day after the insult and results in symptomatic brain ischemia in about 40% of cases. This vasospasm is considered to be a major cause of disability of post-SAH patients. Despite extensive experimental and clinical research, mechanisms of vasospasm are not fully understood. Dysfunction of the endothelium resulting in enhanced production of vasoconstrictors, phenotypic changes of the receptors in endothelium and smooth muscle cells, increased sensitivity of vascular smooth muscle cells to vasoconstrictors, release of spasmogens from lysed blood clot and inflammatory response of the vascular wall have been demonstrated and discussed as pathological mechanisms participating in the development of spasm. In recent years more attention is paid to the functional and structural changes in microcirculation and a concept of microvascular spasm is evolving. Our experimental studies in rat model of SAH strongly suggest that microcirculatory dysfunction and delayed vasospasm are related to the severity of acute, transient ischemia caused by critical decrease of perfusion pressure and active vasoconstriction immediately after the bleeding.

The aim of the present study was to investigate ultrastructural features of cerebral capillaries and the pattern of new vessel formation in a patient with Alzheimer's disease (AD). Recent neuropathological studies have demonstrated that patients with AD have cerebrovascular pathology. Using electron microscopy, we showed that alterations of the capillaries are a common finding both in vascular disease and in AD, suggesting that vascular factors may also play a role in the pathogenesis of AD. We also found regionally increased capillary density, and in many sections immature endothelial cells lying on the preexisting endothelium were present in the lumen of capillaries. These cells might thus contribute to the pathological pattern of capillaries. The cytoplasm of immature endothelial cells in the patient with AD was characterized by accumulation of amyloid fibrils. We suggest that immature endothelial cells may be an important source of circulation-derived amyloid in the brain.

Background and Purpose: The paper presents our own experience with microsurgical clipping of the cerebral aneurysms previously treated using endovascular techniques., Material and Methods: The presented clinical material consists of 3 patients treated in such a way. A group of 60 patients was embolized. An initial satisfactory effect of endovascular treatment was verified within 12 months of observation. Control radiological examinations--plane skull x-ray and cerebral angiography (DSA)--revealed coil displacement and recanalization of the aneurysm. In each case a surgical clipping of the aneurysms was performed., Results: Proper clipping of previously coiled aneurysms sometimes presents a serious problem. Certain difficulties included rebuilding of the aneurysmal wall with a change of anatomical configuration in vessel ramifications., Conclusions: Qualification for endovascular treatment and the existing risk of introduction of additional coils into the aneurysm sac was discussed in connection with our observations. Problems concerning surgical treatment of initially embolized cerebral aneurysms were discussed and illustrated. Radiological monitoring of patients after endovascular treatment was proposed.

The pilocytic astrocytoma is only rarely associated with gross intratumoral hemorrhage despite rich vasculature and blood vessel changes, accompanied often by perivascular depots of hemosiderin. We report an unusual case of pigmented cerebellar pilocytic astrocytoma presenting with posttraumatic hemorrhage in a 38-year-old man with no history related to the tumor. CT and MRI examination after head injury demonstrated unexpectedly the cystic lesion of 2 cm in diameter in the region of the right cerebellar hemisphere and vermis. The lesion was associated with hematoma and it was surgically removed 3 weeks after trauma. Histopathological examination revealed pilocytic astrocytoma tissue with broad hemorrhagic changes and with an unusual pattern of massive pigmentation of the cytoplasm of pilocytic astrocytes, consistent with hemosiderosis. Positive stains for iron and ferritin and ultrastructural study confirmed deposition of hemosiderin granules in the tumour cells. There was no evidence of melanin or melanosomes. This finding of hemosiderin accumulation in the cytoplasm of neoplastic astroglia seems to be analogous to post-hemorrhagic pigmentation of the normal Bergmann glia and subpial astrocytes. In the literature, the examples of neuroepithelial tumors with hemosiderin pigmentation of tumor cells have been rarely documented. To our knowledge, this is the first reported case of pigmented pilocytic astrocytoma exhibiting extensive intracellular hemosiderin deposition.

The aims of the study were as follows: first, to verify the hypothesis that free radical peroxidation may be one of the factors implicated in pathophysiology of normal pressure hydrocephalus (NPH) and, second, to find out whether these biochemical characteristics together with neuropsychological cognitive deficits can differentiate between various types of NPH. This provides prognostic criteria for selection of patients for shunt surgery. Lipid peroxidation was measured in terms of thiobarbituric acid-reactive material (TBAR) and protein sulphydryl (SH) groups were measured as CSF content. Cognitive deficits were assessed using a number of neuropsychological tests. In the sample of NPH patients (n = 24), three categories were distinguished using these criteria: idiopathic active hydrocephalus (A), arrested hydrocephalus (AH), and post-traumatic hydrocephalus (PT). TBAR levels for NPH patients were higher than that of controls without CNS pathology (n = 2). Moreover, NPH patients had increased levels of total and soluble protein groups, and decreased levels of protein SH groups, which suggests the occurrence of processes that activate peroxidation of free radicals in normal pressure hydrocephalus. Levels of these indicators varied across NPH types. Two categories of NPH patients, with active (A) or posttraumatic (PT) hydrocephalus differed significantly from the controls (C)--their TBAR levels were 0.58, 0.56 and 0.28 nmol/mg protein, respectively; soluble SH levels: 41.5; 58.15 and 11.3 nmol/mg protein, and protein SH levels: 34.3, 21.8 and 57.5 nmol/mg protein. In PT group, many individual differences were noticed. These findings seem promising because the studied biochemical indicators may serve as additional diagnostic criteria for selection of NPH patients for shunting.

We have determined the cellular concentration of thyroxine (T4) and triiodothyronine (T3) and the activities of two brain iodothyronine deiodinases, type II (5'-D2) and type III (5-D3), in two types of tissues --tumour (26) and non-tumour (5), derived either from human gliomas with various histological malignancies or from non-tumoural surrounding brain tissue. As it has been established, all patients before the surgery had the Non-Thyroidal Illness Syndrome (NTIS). The concentration of serum T3 was therefore significantly decreased in all the examined patients. It was over 2.5 times lower than that before surgery and 4.0 times lower at surgery than that seen in healthy controls. The serum concentration of T4 was found to be below normal range in 4/26 cases and in low levels of normal range in 6/26 cases, whereas TSH serum concentration in all patients was within normal range. The concentrations of T3 and T4 (expressed as pg of hormone/mg tissues protein) in 22/26 brain tissue samples were significantly lower in gliomas than in 5 non-tumoural brain tissue samples. As expected, the alternation in brain 5'D II activity in gliomas was seen in most cases with astrocytomas (5/8 cases), gliosarcomas (8/8 cases) and glioblastoma multiforme (10/10 cases). In general, the mean enzyme activity in tumour tissue was significantly higher than that found in non-tumoural tissue of human brain (21.79 fmol of newly generated T3/h/mg of protein vs. 4.88 fmol of T3/h/mg protein, respectively). The highest 5'D2 activity with a range from 10.82 to 45.96 (mean 23.61 fmol T3/h/mg protein) was found in gliosarcomas. The activity of 5-D3 was increased (in 8/8 cases of gliosarcoma and in 9/10 cases of glioblastoma multiforme) or decreased (in 3/3 cases of astrocytoma II, 5/5 cases of astrocytoma III) when compared to mean activity of this enzyme found in non-tumoural brain tissue. In summary, our results suggest that the concentration of brain iodothyronines and metabolism of thyroid hormones in the examined human brain tumours are altered. These changes may be related to malignant progression.

In most people the left hemisphere of the brain is dominant for language functions. Because of an increased incidence of atypical language lateralisation in the right hemisphere of left-handed neurological patients, more systematic studies on handedness and cerebral asymmetry of language have been undertaken. The present study is aimed at clarification of the relationship between handedness and language dominance in healthy subjects. Lateralisation was measured directly using functional transcranial Doppler sonography in left-handed subjects. Twenty-six individuals participated in the study. Three kinds of tasks were used, differing in the material involved and in appropriate strategies to be employed by the subjects. Two important parameters of the MCA blood flow were analysed: mean relative increase in the blood flow velocity (MDV) and specific patterns of cognitive task performance (i.e. performance profiles). Our results indicate that the incidence of the right hemisphere dominance for language depends on the degree of handedness, since only in the group of consistent left-handers language was right lateralised. In other left-handers both cerebral hemispheres were functionally equivalent. The measurement of MCA blood flow velocity changes using transcranial Doppler ultrasonography seems to be a simple and non-invasive method of assessing the functioning of the two hemispheres of human brain.

Chordoid glioma is a rare benign neoplasm of uncertain histogenesis occurring in the third ventricle/ /suprasellar region. Recently, data have emerged suggesting that chordoid glioma is a variant of ependymoma related to a specialised ependyma of the subcommisural organ or the lamina terminalis area. In this study, we report clinicopathological and ultrastructural findings in two chordoid glioma cases. In case 1, a tumour (1.5 cm in diameter) in a 62-year-old man invaded the anterior-basal part of the third ventricle in the lamina terminalis region. In case 2, a large tumour in a 51-year-old woman occupied the whole third ventricle. The tumour attached to the medio-basal hypothalamic region. Histologically, both cases revealed a distinct chordoma-like pattern and glial immunophenotype of tumour cells. Under the electron microscope the tumour cells exhibited microvilli, intercellular lumina, intermediate type junctions and focal basal lamina formations. These findings were similar to those previously reported in the chordoid glioma cases. Moreover, the intracytoplasmic cilia and subplasmalemmal pinocytic vesicles or caveoles were observed. The study supports the view of ependymal derivation of chordoid glioma. Its relation to lamina terminalis or infundibular/median eminence area presumably reflecting tumour origin from the modified ependyma of circumventricular organs of the third ventricle is discussed.

Over the last 25 years there have been reports from the widely recognised neurosurgical centres on the positive clinical results of partial and even complete removal of brainstem tumours. They confirmed relatively high incidence of benign tumours like low-grade gliomas and haemangioblastomas in this region. Based on imaging studies (MRI) and surgical experiences, brainstem tumours can be divided into focal and diffuse. Focal lesions are amenable to surgery; particularly, those with a prominent exophytic portion. Open surgery remains controversial in pure intrinsic brainstem tumours as the surgical approach itself may lead to serious postoperative complications. Different approaches (including the most frequent one--through the fourth ventricle floor) are used depending on the tumour location. As minimal invasiveness is mandatory during transtegmental route safe approach zones within the rhomboid fossa were defined morphologically and morphometrically--suprafacial and infrafacial (i.e., situated above and below facial colliculus, respectively). Application of the proposed minimal invasive surgical approach through the fourth ventricle floor should reduce postoperative morbidity and mortality in patients with tumours in pons and upper medulla oblongata treated surgically.

The aim of the work was to evaluate the efficacy of microvascular decompression (MVD) in different types of vascular compression (VC) in 20 patients with the idiopathic form of trigeminal neuralgia (TN). The typical VC was found in 17 cases. An arterial vessel was the cause of VC in 6 cases, a venous vessel in 5. The mixed type of VC was present in 6 cases. In every case of the mixed VC one of the vessels compressing the 5th nerve predominated: arterial in 5 and venous in 1. In 3 cases of TN no VC was found. Observation time after MVD was from 6 to 61 months (median 26.7 months). In the TN patients with the arterial VC (including the mixed VC with the arterial predominance) pain relief was complete in 7 cases, satisfactory in 2 and none in 1 case. In patients with venous VC (including mixed VC with venous predominance) pain relief was complete in 4 cases and satisfactory in 2. In the TN patients without VC pain relief was satisfactory in 1, unsatisfactory in 1 and none in 1 case. Long term results of MVD in the analyzed series of the TN patients confirm the efficacy of MVD when vascular compression of the 5th nerve--either arterial or venous--is found intraoperatively.

Over-proliferation of certain cells lead to tumor formation and therefore impairments of regulation of the cell cycle are inalienable and basic signs of neoplasms. The majority of known oncogenes and tumor suppressors are components of a few common signaling pathways that control the cell cycle, genome integrity, cell differentiation and apoptosis. Changes in these signaling pathways cause the development of tumor genesis. The thyroid hormones (3, 5, 3'-L-triiodothyronine, T3; 3, 5, 3', 5'-L tetraiodothyronine, T4; TH) play crucial roles in the growth and differentiation of many organs, including the central nervous system. TH exerts its major effect by binding to the nuclear TH receptor (TR). TR is bound to specific DNA sequences known as TH-response elements (TREs), composed of two half-site core motifs (AGGTCA), with specific nucleotide spacing and orientation. TR also bind to several coregulators such as corepressors and coactivators. The liganded complexes ultimately determines nuclear TH action. .

The development and progression of astrocytic tumours is associated with acquisition and accumulation of genetic alternations. Loss of heterozygosity (LOH) on chromosome 17p., p53 mutations and overexpression of the platelet-derived growth factor (PDGF) receptor (chromosome 22q), are the most common detectable changes in astrocytomas (WHO grade II). Anaplastic astrocytomas (WHO grade III) involve LOH on chromosome 19q, deletion of p16 tumor suppressor gene on chromosome 9p and disturbed expression of gene RB on chromosome 13q. LOH on chromosome 10 is restricted largely to glioblastomas (WHO grade IV). This tumour also is characterized by amplification and/or overexpression of gene coding Epidermal Growth Factor Receptor (EGFR) on chromosome 7p. There is growing evidence that two genes encoding triiodothyronine receptors TR alpha [17q21] and TR beta [3p21-p25]) belong also to the group of genes involved in tumorigenesis. Mutations of these genes as well as markedly disturbed expression and function of the encoded proteins were found in tumour tissue. This is supported by facts. that T3 via TRs regulate proliferation, growth, differentiation and apoptosis, the processes that are deeply disturbed in tumour tissue. TRs affects also the action of certain protooncogenes (Mdm2) and tumor suppressors (p53, Rb).

Objective: The goal was to develop a fast and efficient neurosurgical teleconsulting network to improve acute neurosurgical patient care, to reduce transport costs and unnecessary occupation of neurosurgical beds., Methods: Modems with 56 kilobits/s data transmission speed are used. CT images are transmitted straight from CT scanner via modem/telephone lines to receiving personal computer in Department of Neurosurgery. Receiving PC runs with Microsoft Windows operating system and the network software MultiView (EMED, Inc.). Network connects Department of Neurosurgery Polish Academy of Sciences in Warsaw with transmitting hospitals in Ciechanów and Ostrołeka., Results: The system is fast, one study consisting 18 images is transmitted in about 5 minutes and it is simple to use, to date more than 1000 CT images have been transmitted. Operator acceptance has been very high. The system has improved acute neurosurgical patient care. Transfer of appropriate patients has been accelerated and unnecessary transfer is almost eliminated., Conclusion: Applied Neurosurgical Teleconsulting System has significantly improved acute neurosurgical patient care and has reduced transport expenses. Better availability of neurosurgical consultation has been achieved. The network is simple to use and has gained physician acceptance. It has to be emphasized that the creation and using of the system is relatively not expensive.

Von Hippel-Lindau disease (VHLD) is an autosomal dominant disorder predisposing to the development of different histological types of tumours with predominance of CNS haemangioblastomas in the majority of cases. We present a case of a 35-year-old man with obstructive hydrocephalus due to multiple posterior fossa tumours. Familial history revealed two relatives operated on previously because of a posterior fossa tumour (in one case haemangioblastoma was diagnosed). During surgery two cerebellar tumours were removed radically via the suboccipital approach. On a histopathological examination the typical features of haemangioblastoma were found in both tumours composed of stromal cells and a dense network of vessels, mostly capillaries. The presence of neoplastic infiltration with angiogenesis in the surrounding cerebellar tissue was evidenced in the presented case. Based on the clinical and histopathological data VHLD was diagnosed. Genetic analysis confirmed the presence of the von Hippel-Lindau gene mutation. The case presented suggests that genetic disregulation in VHLD may be responsible for a more aggressive behaviour of VHLD-related haemangioblastomas in comparison with sporadic disease.

In surgical treatment was performed of patients after cerebral ischaemic stroke and cerebral ischaemia. The authors applied the surgical technique of indirect anastomosis (EDAS-encephalo-duro-arterio synangiosis). The Japanese authors described this method first as a treatment for moya-moya disease. The acetazolamid (Diamox) test and clinical symptoms were the main criteria to perform this surgical procedure. All patient with abnormal Diamox test were treated surgically. After 6 months control angiography was performed to visualize a new network of vessels near the main vessel (superficial temporal artery).

The placement of tungsten coils into aneurysm sack in patient after SAH is a method of treatment used in many neurosurgical departments. The main indications for coiling procedures are severe neurological status (IV i V according to WFNS) and posterior circulation aneurysms. Coiling can be offered to a patient who does not agree to clipping procedure. The presented case is a patient with a giant MCA aneurysm who did not agree to clipping procedure and, therefore, was subjected to coiling. During the follow-up of 2 months; control skull X-rays and after them control angiography were performed to monitor coils arrangement in the aneurysm sack and their possible dislocation. The control angiography after 6 months showed significant enlargement of the aneurysm. The aneurysm was clipped, totally excised and subjected to histopathological examination. It was found that the material inside the aneurysm sack can change its shape due to the impact of the flowing blood (change in the coil shape, resorption and the recanalization of the clot) similarly to the natural process of aneurysm development. Morphological changes of the aneurysm appear to be also possible in spite of the thrombus formation in the aneurysm sack.

The reported case was a patient with tumour situated in the region of the corpus callosum, with symptoms diagnosed initially as affective syndrome and later on as paranoid syndrome. With this diagnosis he was treated for 12 years in psychiatric out-patient clinics and hospitals with antidepressants and and neuroleptics. Brain imaging (CT and MRI) performed only after an epileptic seizure demonstrated a tumour in the anterior part of the corpus callosum with a broad oedema area. Neuropsychological examination revealed disturbances of emotional-motivation processes and defects in cognitive functions. Following surgical treatment only a slight improvement of functioning was noted. Histological diagnosis (PNET) suggested that the tumour was expanding during many years. Much earlier diagnosis with neurosurgical intervention could result in a better therapeutic effect.

Indication to translabyrinthine approach to removing of the cerebello-pontine angle tumors--anatomical aspects. Translabyrinthine approach was used in surgical procedures performed for stage II, III and IV tumors of the cerebello-pontine angle of various sizes in 15 cases. In order to ensure a correct course of the procedure and successful removal of the tumor, translabyrinthine approach should be carefully planned on the basis of radiological criteria (CT, NMR). Anatomical limitations of the approach are connected with the localization of the sigmoid sinus, the bulb of the internal jugular vein, pneumatization of the mastoid process and the location of the superior petrosal sinus. In approach planning it should be considered whether the bulb of the internal jugular vein is not located high in relation to the internal auditory meatus, what is the meatus diameter (IAC), location of the sigmoid sinus--its shift to the front is a serious limitation for the approach. The pneumatization state of the mastoid process is also important because of the duration of petrosectomy. Taking into consideration the aforementioned conditions allows to plan precisely and perform the approach appropriate for the tumor size.

Results of removal of vestibular schwannomas using translabyrintine approach were presented. 12 unilateral neuromas were operated. Large neuromas with diameter above 2 cm constituted 75% of all cases. The total resection of tumors was achieved in 10 patients. In all cases anatomical integrity of facial nerve was conserved. In 7 patients facial nerve function was in stage I-III (House Brackmann classification). There were not life threatening complications. Authors underline, that the translabyrintine approach permits to obtain enough wide insight to ponto-cerebellar angle to remove safely, both little and large, vestibular schwannomas.

On the basis of the presented clinical material, the authors present their own observations concerning qualification of the patients with cerebello-pontine angle tumors for surgery utilizing the translabyrinthine approach. The clinical material includes 15 cases of stage II, III and IV cerebello-pontine angle tumors removed through translabyrinthine approach. In view of the fact that there are different opinions concerning the selection of appropriate surgical approach and of a conviction that translabyrinthine approach should be used in case of stage II, relatively small tumors, and that larger, stage III and IV ones should be operated on using the retromastoid approach, we are presenting our views concerning the qualification of patients. In our opinion, the translabyrinthine approach can be used for larger tumors--also for stage IV ones. The translabyrinthine approach was considered only in the cases with total hearing loss and not useful hearing. Of course, in the cases when the tumor penetrates into the middle cranial fossa or into the foramen magnum, the approach may prove rather difficult. As it has been known, the dimensions of the access route are determined by three main anatomical structures: altitude of the bulb of the internal jugular vein, location of the sigmoid sinus and the diameter of the internal auditory meatus. The fundamental advantages of the approach include: no cerebellum retraction required in the case of classic retromastoid approach, easy anatomical and neurophysiological identification of the course of the facial nerve and maintaining its continuity. An approach involving damage of internal ear structures can be performed only if the patient is deaf.

Various isolation materials have been used in the treatment of trigeminal neuralgia due to neuro-vascular conflict. Surgical treatment (MVD) currently utilizes for isolation soft teflon pladgets, which are, after appropriate preparation, placed in the form of wool between the conflicted structures. The materiał was used in 20 surgical procedures. The definite advantage of this materiał as compared to others is the possibility to position it correctly between the blood vessel and the nerve without additional fixation with e.g. a tissue adhesive. Observations indicate that this is the best isolation materiał of those used so far in MVD procedures.

The aim of this work is to evaluate middle cerebral arteries (MCA) blood flow velocity changes during performance of linguistic and visuospatial cognitive tasks. Two groups were investigated: eight patients with suspected hydrocephalus without perceptible cognitive disturbances, and eight healthy persons. Blood flow velocity in left and right MCA was recorded with transcranial Doppler sonography while the examined patients were performing three different tasks. The analysis of the results showed differences between the groups concerning both increase of blood flow velocity values and performance patterns. Compared to healthy individuals less increase in blood flow velocity during performance of all tasks and no difference in haemodynamic changes between both hemispheres during task performance were observed in patients with hydrocephalus. The results obtained suggest, that the pattern of functional lateralization in brain in patients with suspected hydrocephalus is probably changed.

Disturbances of the cerebrovascular reactivity in cases of migraine with aura are well-known. It has been suggested that the vasostabilizing effects of novel prophylactic pharmaceuticals are determined by their antiserotoninergic and/or nitric oxide releasing properties. Dotarizine, a representative of Ca2+ channel blockers from diphenilbutilpiperazines group also reveals antiserotoninergic 5-HT2A and 5-HT2C receptor-specific properties. The vasodilatatory and antivasoconstrictive properties of this compound were reported previously. In this study the efficacy of Dotarizine chronic oral administration on cerebrovascular reactivity during hyperventilation was examined with respect to its duration of action. Experiments were carried out on 13 rabbits. There was an interval of two days between a five days compound administration and performed hyperventilation. Blood flow velocities (BFV) in the middle cerebral artery (MCA) and basilar artery (BA) were measured in control conditions, after 10 min hyperventilation and in the tenth minute of recovery of normoventilation. Our data reveal a decrease of antivasoconstrictive properties of Dotarizine between its administration and vasoconstrictive test. Subsequent normoventilation showed a distinct vasostabilising effect of this compound with evident regional differences in its influence on cerebral vessels. Thus Dotarizine might be useful as prophylactic medication in migraine therapy, due to its Ca2+ channel blocking and antiserotoninergic properties, but the time-frame of its efficacy has to be defined.

Cerebral aneurysm clipping is a widely used and accepted treatment option. However, in some patients in severe condition (IV and V WFNS grade), with aneurysms of basilar and vertebral part of the arterial circulation and with high general surgical risk, direct aneurysm surgery can be a real technical and clinical problem. Therefore, low risk of coiling procedures gain more and more support. Out of 218 patients with diagnosed aneurysms, 60 were selected for coiling treatment, and 15 patients with multiple aneurysms were treated with both procedures. Special attention has to be addressed to the selection of patients for coiling procedures, especially in the cases when aneurysmal neck is directed accordingly to the main blood stream. The follow-up of the treatment effects is necessary. In the cases with growing aneurysms clipping is recommended. In the cases with stable size of the aneurysmal sack and visible coils compression, the coiling procedure is repeated. The coiling procedures can offer a valuable treatment option for selected patients. However, the maintenance of permanent occlusion of the aneurysm sack after coiling gives rise to some controversy.

The aim of our study was to investigate the blood flow in middle cerebral arteries during the different forms of cognitive activity in dyslectic persons. Two group of subjects were tested. The first group consisted of 10 students with school difficulties, diagnosed neuropsychologically as having a particular form of dyslexia, i.e. dysgraphy or dysorthography. 6 of them were right lateralized and 4--left lateralized. The second contained 10 students without such problems. 7 of them were right lateralized and 3--left lateralized. We used four kinds of cognitive tasks, during which the blood flow velocity in MCA in left and right hemisphere was measured with the Transcranial Doppler method. The analysis of the results showed differences between the groups of blood flow velocity levels, without a difference in performance profile. The dysgraphic persons had significantly higher blood flow velocity in the right hemisphere compared to the reference group. The results suggest particularly important role of right hemisphere in dyslexic persons, which is consistent with results obtained by other authors. The analysis of lateralization showed that this factor influences significantly the blood flow velocity level--the left lateralized persons showed lower rise of blood flow velocity than the right lateralized, regardless of the kind of task and measured hemisphere.

Several types of cerebral blood flow disturbances, resulting from head trauma are discussed. Application of Transcranial Doppler Sonography in diagnosing of posttraumatic cerebral vasospasm and cerebral hyperaemia, increased intracranial pressure, autoregulation disturbances, and brain death is described. Clinical examples of isolated cerebral blood flow disturbances, and several types of their co-existence are given. Special attention was paid to the noninvasiveness, repetitiveness, and relative ease of use of the technique. Transcranial Doppler examination can be especially useful in diagnosis and monitoring of different cerebral blood flow disturbances, which is especially important in therapy of brain trauma patients.

The method of blood flow velocity (BFV) evaluation by intraoperative application of the high frequency Doppler is presented. The device is used to estimate BFV changes in small caliber arteries by direct placement of the probe upon the examined vessel. BFV examinations were performed on the site during aneurysm operations, during transsphenoidal approaches to identify the intracavernous portion of ICA embedded in the tumor mass and in patients after encephalodurosynangiosis evaluated on the outpatient basis. Technical characteristics of the flowmeter used are described and examples of the BFV pictures in cerebral arteries are presented. The device allows a precise BFV evaluation in the selected vessel and detection of changes in BFV patterns particularly useful during aneurysms surgery. This method of identifying cerebral vessels may become applicable in other types of neurosurgical operations.

The Japanese authors first described encephalo-duro-arterio-synangiosis, a new treatment for moya-moya disease, 17 years ago. The other authors used this method (EDAS, indirect anastomosis) in surgical treatment of patients suffered cerebral transient ischaemic attack and cerebral ischaemia. In our department this method was applied in 5 patients with cerebral ischaemia. All patients had internal carotid artery occlusion. After angiography, to localize carotid artery occlusion, acetazolamid (Diamox) test was performed. The patients with negative Diamox test were treated surgically (EDAS). The authors used the intraoperative microdoppler device to monitor blood flow velocity of the prepared vessel (temporal superficial artery) at every stage of surgery. The device was also useful in controlling the patency of encephalo-duro-arterio-synangiosis percutaneously after the surgery. The proximal and the distal part of the non-bypass anastomosis was examined in the follow up during 5-8 months before angiography.

The flowmeter enables estimation of blood flow velocity changes in small calibre arteries. The authors examined blood flow velocity patterns in the vessels during aneurysm operations and blood flow velocity and its disturbances inside aneurysm. Evaluation technique, technical data of the flowmeter use are described and the characteristics of the blood flow velocity picture in cerebral arteries obtained by this method is presented. The presented method enables a very precise estimation of blood flow velocity and detection of changes in flow patterns. The method may become very helpful in identification of the vessels in other types of cerebral surgery.

Dotarizine--the novel piperazine derivative--belongs to wide spectrum Ca2+ channel antagonists. It was reported to have strong vasodilatatory and antiserotoninergic activities. Comparing with other Ca2+ channel blockers Dotarizine was found to have lower oral toxicity. In the present study the influence of the oral administration of the novel compound on the blood flow velocity changes in different cerebral arteries--in basilar artery (BA) and middle cerebral artery (MCA)--was investigated under hypoxic conditions. The ultrastructural morphological changes of intracerebral vessels endothelium in treated and untreated anoxic animal groups were also demonstrated. The experiments were carried out on rabbits. In the experimental group 25 mg/kg of Dotarizine dissolved in 0.25% agar was administered orally three times at the 10 hours' intervals. The sham group of animals was fed with agar of the same concentration. During anoxic conditions strong vasodilatory effects were observed in both investigated vessels of drug-treated animals. In the experimental group marked ultrastructural differences in parenchymal vessel endotheliumin comparison to sham group were revealed. Thus, the oral administration of Dotarizine might have effect on the various parts of the cerebrovascular system and can play significant role in improvement of various cerebrovascular disorders.

Multistage method of low-pressure hydrocephalus diagnosis, elaborated in our department, is discussed. The method consists of four stages: I Clinical and neuropsychological examinations, standard computerized tomography. II Somatosensory evoked potentials. III Determination of water concentration and distribution in fluid compartments of the brain by utilising new mathematical formula. IV Three-phase complementary test. The application of this method allows to eliminate many false diagnoses and may contribute to lower costs of treatment.

Forty brainstems were investigated in order to evaluate morphological and morphometrical variability of the 4th ventricle floor. Visibility evaluation of the following rhomboid fossa structures: striae medullares, facial colliculus, superior fovea, vestibular area, sulcus limitans, incisure, medial eminence, median sulcus, vagal triangle, hypoglossal triangle and obex was performed. Obex, median sulcus, vestibular area, vagal and hypoglossal triangles were found to be sufficiently visible in all specimens. Facial colliculus was poorly visible in 37% of the examined brainstems. Striae medullares were invisible in 30% of the analysed material and exhibited individual variability of a high degree in relation to their number and arrangement. Morphometrical study showed measured distances to be individually variable with a relatively low coefficient of variation of approximately 10%.

Dotarizine--a novel piperazine derivative--belongs to wide spectrum Ca+ channel antagonists. It was reported to have strong vasodilatory and antiserotoninergic activities. Unlike other Ca+ channel blockers Dotarizine was found to have lower oral toxicity. In the presented study the influence of the oral administration of the novel compound on the blood flow velocity changes in different cerebral arteries--in basilar artery (BA) and middle cerebral artery (MCA)--was investigated under hyperventilation and hypoxic conditions of rabbits. In the first experimental group 25 mg/kg of Dotarizine dissolved in 0.25% agar was administered orally three times at the 10 hours' intervals. The sham group of animals was fed with agar of the same concentration. The results revealed that oral administration of Dotarizine diminished the vasoconstrictive effect of hyperventilation and this was more pronounced in MCA than in BA. During anoxic conditions stronger vasodilatory effects were observed in both groups of vessels and the low value of pulsatility index (PI) reflected pronounced decrease of the peripheral resistance, in comparison to the control group. Thus, the oral administration of Dotarizine decreases the peripheral resistance of cerebral vessels and therefore seems to have influence on the minute arteries of cerebrovascular system of the brain.

The preliminary studies on cerebral blood flow changes during neuropsychologic tests were carried out using transcranial Doppler sonography (TCD). The procedure with the standardized cerebral activation in order to obtain the control brain activity level was elaborated and tested. Blood flow velocity changes were measured during two groups of tests: linguistic with left dominant hemisphere and visual-spatial with right dominant hemisphere. Similar dynamics of blood flow changes was observed with all kinds of brain activation with the maximum velocity increase of 15-20%. The velocity measured in the dominant hemisphere was about 8-10% above the contralateral side. TCD seems to be complementary to the neuropsychologic tests useful especially in diagnosis of different types of dementia.

A new CSF circulation diagnostic procedure is presented. The method is called three-phase infusion test. In phase I the CSF absorption mechanisms were tested within ICP range below 20 mmHg and then the infusion rate of 0.06 ml/min was applied. In phase II the high infusion rate (0.3 ml/min) was used and high ICP increase occurred. This part of the study provided data concerning the ability of alternative CSF outflow routes. In phase III again low infusion rate (0.06 ml/min) was applied. The obtained CSF outflow data in phase III were significantly lower than in phase I. This is the so called persistent outflow facilitation phenomenon. The method described, covering different mechanisms of CSF absorption, enables the complex evaluation of CSF outflow sufficiency.