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Surgery of Parkinson's disease started in the middle of the last century. At the same time this treatment was introduced in Poland. Choróbski removed Broadsman's area 4 through craniotomy. In 1961 Liszka in Kraków introduced the stereotactic procedures, thalamo- and pallidotomy. This type of surgery was soon introduced in two other neurosurgical centers. For the next several years treatment was mostly pharmacological. However, stereotactic treatment was used in patients poorly tolerating drugs. In the meantime first attempts were made at implantation of fetal substantia nigra, with good results. At the end of the century in several patients electrostimulators were implanted. In the last century all known methods of surgical treatment were applied in Poland.

Results of the surgical treatment of temporal lobe epilepsy--Authors present their own experience in the surgical treatment of temporal lobe epilepsy. 403 patients were operated upon. The age of the patients was not limited. The beginning of the epilepsy was in most cases in early childhood, however the conservative treatment was continued for a very long time, usually over 10 years. The modern diagnostic tools, especially MRI, make it possible to diagnose the temporal epileptic focus more often, than previously, especially in cases with morphological substrate. Temporal lobectomy with amygdalo-hippocampectomy was performed. The follow-up was at least 3 years after surgery. Outs of 343 patients examined in this period 175 were cured, without seizures after surgery. Next 61 patients had no more than 2 small attacks a year. So in 69% of patients the result was very good or satisfactory. The neuropsychological investigation revealed that in most patients the IQ improved. Their quality of life improved markedly according to their own opinion.

In the course of histopathological investigation of the temporal lobe sections, selected from 63 patients treated surgically for intractable epilepsy and finally presented with primary temporal tumors, we found 12 cases expressed both neoplastic process' and developmental disorders. The temporal mass lesions consisting of neuro-glial or pure glial tumors were associated with some developmental abnormalities such as cortical dysplasia, neuronal heterotopias and additional cortical neoplastic nodules. The possible "dual pathology" concerning these lesions are discussed in this paper.

The aim of the study was to analyze intensified ocular symptoms of patients with diagnosed and surgically treated pituitary macroadenoma. Material from Neurosurgery Clinic of Medical University in Warsaw covering the period since 1935 was included in the study. Duration of the period from first ocular symptoms to final diagnosis as well as condition of visual organ, especially number of patients with irreversibly damaged sight (blindness, marginal vision), were evaluated. The results of the study show that still a great number of patients undergo surgical treatment too late; in the last period 36% of patients had irreversibly damaged sight. The reason was found to be partially carelessness of the patients, however in many cases it was wrong initial medical diagnosis and not performed full diagnostic examinations. The study points to the necessity of performing adequate additional tests in cases of patients with visual field narrowing or visual acuity deterioration without clearly determined other pathology.

The purpose of the study was clinical analysis of the patients with Arnold-Chiari malformation and the definition of the groups according to the clinical presentation. The authors present the series of 210 patients treated between 1980 and 1997 in the Department of Neurosurgery. These patients were classified into 4 groups: syringomyelia, cerebellar syndrome, cerebello-spinal syndrome and hydrocephalus. Syringomyelia was the commonest clinical presentation in the series. Less often cerebellar and cerebello-spinal syndromes were observed. Non-communicating hydrocephalus was rare. The symptomatology of the Arnold-Chiari malformation appears extremely variable, but most often is related to the associated cavitation of the spinal cord. The signs and symptoms in patients presenting cerebellar syndrome may lead to misdiagnosis of insufficiency of the vertebrobasilar circulation. Diffuse involvement of the motor and sensory system with cerebello-spinal syndrome may cause the patient to be diagnosed incorrectly as having sclerosis multiplex. The MR is the method of choice in the diagnosis of Arnold-Chiari malformation.

Colloid cysts of the 3rd ventricle, diagnosis and treatment. 11 patients with colloid cyst of the 3rd ventricle were diagnosed and treated at the Department of Neurosurgery the Medical University of Warsaw, between 1987 and 1996. The patients comprised 5 females and 6 males, aged 22 to 58 years. Mean time from the occurrence of the first symptoms to surgery was 23 months, although this varied in individual cases from 8 days to 10 years. In the majority of patients, the leading symptoms were: headaches, nausea, vomiting and papilloedema, comprising symptoms of high intracranial pressure. Slowly progressing symptoms of organic brain damage syndrome were observed in 5 patients. Preoperative diagnosis was based on CT of the head in 8 patients, on NMR in 2 and on both CT and NMR in 1 patient. At the first stage of treatment, a ventriculo- peritoneal Y-shunt was used in 3 patients to eliminate symptoms of high intracranial pressure. All patients then underwent radical surgery. 9 patients were treated by craniotomy in the frontal region with incision of the cortex and then through the lateral ventricle and interventricular foramen. 1 patient was operated by craniotomy and through the terminal lamina of the 3rd ventricle. In 1 case the cyst was evacuated via neuroendoscope. There were no cases of mortality among our patients. Full recovery occurred in 8 patients. In 3 patients symptoms of organic brain damage syndrome observed prior to surgery remained, but in a lesser degree, which may be a result of the correct diagnosis being established too late. In over 5 years' follow-up, no cases of recurrence were observed.

Unlabelled: MATERIAL, METHOD: Authors present the results of surgical treatment in a series of 93 patients with medically intractable epilepsy and large epileptogenic foci, in whom multilobar resections have been performed. They constituted 13% of a group of 716 patients subjected to surgery due to drug resistant epilepsy in the period 1957-1996, in the Department of Neurosurgery, Medical University of Warsaw, Poland. Patients treated with multilobar resection constituted the group, characterised by the most severe course of epilepsy, so they usually had a long seizures' history at the time of operation (more than 10 years duration of the disease in 37% of patients), albeit they were qualified to surgery at a relatively young age (mean age at the time of surgery: 16-th year of life). Trauma was the most frequent underlying aetiologic factor (perinatal trauma and other major head injury were documented in 28% and 30% of patients respectively). Morphological abnormalities of the resected brain tissue were found on pathological examination (light microscope) in 68% of patients in this series., Results: Perioperative mortality was 3%. At a follow-up examination (mean follow-up period 7 years postoperatively): 30% of patients were seizure free, in 13% of patients drug discontinuation was possible. In 23% of patients less than 2-3 seizures per year occurred. So totally in 53% of patients, good result of treatment was achieved (none or only very rare seizures). In 35% of patients surgery failed to control seizures' frequency. 9% of patients were lost from follow-up evaluation., Conclusions: Multilobar resection (if acceptable from the clinical point of view) may be an effective treatment choice in patients with medically uncontrollable seizures and huge epileptogenic foci. This treatment modality may offer recovery from seizures or significant improvement to 53% of patients treated. The radical removal of epileptogenic foci, age of the patients higher than 18 year of life at the time of operation, focal character of EEG abnormalities and occurrence of only one type of seizures, were found to be good prognostic factors. On the other hand younger age of the patients operated, the presence of generalized slow waves in the interictal EEG recordings and the occurrence of various types of seizures, influenced adversely on the prognosis.

Unlabelled: The acute (ECoG) was examined in 291 patients with intractable epilepsy, without structural brain lesion--from 1971 to 1997. Temporal lobectomy was performed in 198 cases and extratemporal (frontal, parietal or occipital) in remaining 93 cases to achieve seizure control. Epileptic foci was activated during acute ECoG by i.v. administration of ketamine (154 cases) or short-acting barbiturates--methohexital (110 cases) and thiopental (27 cases)., Results: Ketamine significantly more often caused ECoG identified electrographic seizures than methohexital: p = 0, 00001 or thiopental, which in no cases resulted in seizures. Also electrographic seizures occurred more frequently after administration of ketamine in patients with the extratemporal seizure focus localisation in comparison with temporal focus (p < 0.05). Electrographic seizures provoked after administration of ketamine improved the localisation of the area to be resected, more often in extratemporal epileptic foci., Conclusions: The results of our investigations indicate that ketamine more effectively activated epileptic focus than short-acting barbiturates.

Unlabelled: The aim of this study was to investigate the value of structural neuroimaging with MRI in the selection of patients for epilepsy surgery. We sought to determine whether MRI influenced decision concerning resective surgery and whether MRI provided much more useful information than enhanced CT., Materials and Methods: Neuroimaging studies, MRI and CT, of 300 patients; 265 with partial and 35 with primary generalized seizures, evaluated for surgical treatment of epilepsy were analysed. The MRIs and CTs were interpreted using visual diagnostic criteria and findings were correlated with the EEG changes and clinical semiology., Results: MRIs identified structural lesions in 142, CTs in 96 of all patients. The clinical semiology (partial seizures), MRI, CT and EEG focal findings were concordant in 72 cases. The group of 34 patients had resective surgery. The 7 patients were also operated with MRI and CT focal abnormalities discordant with EEG changes. Also one patient with primary generalized epilepsy and temporal lobe lesion (glioma) had resective surgery. MRI studies revealed structural lesions in 48 patients with normal CT studies. The 43 patients with partial epilepsy had normal CTs and lesions in MRIs; the 34 cases revealed correlation with the EEG findings in 29 temporal and 5 extratemporal regions. Surgery were performed in 23 cases. Also one with partial seizures and MRI detected hippocampal atrophy was operated, despite of generalized EEG patterns. In contrast CT revealed two patients with normal MRI and focal changes. The patients with partial seizures and only CT abnormalities (focal calcifications) were not operated due to discordant EEG findings. In group of 132 patients with normal neuroimaging studies and EEG identified seizure focus only 27 had anterior temporal lobectomy., Conclusion: MRI studies gave additional information in case of 16% patients with intractable epilepsy in comparison with CT findings. Resective epilepsy surgery was almost twice as often performed when MRIs revealed structural abnormality. In operated patients, diagnostic sensitivity of structural MRI, CT and EEG to neurophatology were 70.6%, 46.7 and 92.4% respectively.

The authors present some clinical aspects of their own experience in the operative treatment of clinoidal and en-plaque suprasellar meningiomas which account for 5.6% of all intracranial meningiomas in Department of Neurosurgery treated in the years 1987-93. Visual loss was the first symptom of disease. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. Possibilities of total removal are limited by the size of tumour and compression of adjacent structures, and the chance for visual improvement is low for that reasons. Visual improvement was observed in only one case after surgery, however in 5 cases worsening of visual acuity was noted in postoperative period. Mortality rate was 6.2%. Adjuvant radiotherapy was performed in non patient. Long term results in ophthalmological and neurological aspects are discussed.