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This article presents an abstract of the research paper "Can the Level of Sulfane Sulfur Be Related to the Grades of Glioma Malignancy?," which was discussed in the 13th Conference of the Polish Association of Neuropathologist. In most mammalian tissues, cysteine, a sulfur-containing amino acid, is metabolized to cysteine sulfinic acid, which is either decarboxylated to hypotaurine and then oxidized to taurine, or transaminated, leading to the formation of inorganic sulfate. Alternatively, cysteine undergoes desulfuration by several enzymes present in animal tissues. Sulfane sulfur atoms created by the action of these enzymes are involved in the detoxication of cyanide and inorganic sulfide.

High-grade gliomas are aggressive, deadly primary brain tumors. Median survival of patients with glioblastoma (GBM, WHO grade 4) is 14 months and <10% of patients survive 2 years. Despite improved surgical strategies and forceful radiotherapy and chemotherapy, the prognosis of GBM patients is poor and did not improve over decades. We performed targeted next-generation sequencing with a custom panel of 664 cancer- and epigenetics-related genes, and searched for somatic and germline variants in 180 gliomas of different WHO grades. Herein, we focus on 135 GBM IDH-wild type samples. In parallel, mRNA sequencing was accomplished to detect transcriptomic abnormalities. We present the genomic alterations in high-grade gliomas and the associated transcriptomic patterns. Computational analyses and biochemical assays showed the influence of TOP2A variants on enzyme activities. In 4/135 IDH-wild type GBMs we found a novel, recurrent mutation in the TOP2A gene encoding topoisomerase 2A (allele frequency [AF] = 0.03, 4/135 samples). Biochemical assays with recombinant, wild type (WT) and variant proteins demonstrated stronger DNA binding and relaxation activity of the variant protein. GBM patients carrying the altered TOP2A had shorter overall survival (median OS 150 vs 500 days, P = .0018). In the GBMs with the TOP2A variant we found transcriptomic alterations consistent with splicing dysregulation. luA novel, recurrent TOP2A mutation, which was found exclusively in four GBMs, results in the TOP2A E948Q variant with altered DNA binding and relaxation activities. The deleterious TOP2A mutation resulting in transcription deregulation in GBMs may contribute to disease pathology., (© 2023 UICC.)

BACKGROUND This prospective study included 179 patients with degenerative stenosis of the lumbosacral spine and aimed to evaluate the outcomes of conservative treatment and surgical decompression on quality of life and disability over 12 months. MATERIAL AND METHODS The surgery group consisted of 96 patients with degenerative stenosis of the lumbosacral spine who qualified for surgical decompression, while the conservative-treatment group included 83 patients who qualified for conservative treatment. We used the Satisfaction with Life Scale questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire, the Visual Analog Scale to assess the severity of pain, the Oswestry Low Back Pain Disability Questionnaire to assess the degree of disability, and the Sexual Satisfaction Scale at 0, 1, 6, and 12 months after treatment. RESULTS Statistical analysis showed a positive relationship between conservative and surgical treatment and quality of life (P<0.05). A significant reduction in the severity of pain (P<0.05) and the degree of disability (P<0.05) were both recorded during the 12-month followup period in both groups. Women of both groups declared significantly lower satisfaction than men at every time point (P<0.05). CONCLUSIONS Most patients in both groups declared an improvement in their quality of life, with the surgery group showing a higher percentage of responses that their quality of life had improved. Based on the results obtained from the FACIT-F questionnaire, degenerative stenosis of the lumbosacral spine had a non-root effect on the patients' lives in the surgery group.

Glioblastomas (GBM) are the most common, primary brain tumors in adults. Despite advances in neurosurgery and radio- and chemotherapy, the median survival of GBM patients is 15 months. Recent large-scale genomic, transcriptomic and epigenetic analyses have shown the cellular and molecular heterogeneity of GBMs, which hampers the outcomes of standard therapies. We have established 13 GBM-derived cell cultures from fresh tumor specimens and characterized them molecularly using RNA-seq, immunoblotting and immunocytochemistry. Evaluation of proneural (OLIG2, IDH1 R132H , TP53 and PDGFRα), classical (EGFR) and mesenchymal markers (CHI3L1/YKL40, CD44 and phospho-STAT3), and the expression of pluripotency (SOX2, OLIG2, NESTIN) and differentiation (GFAP, MAP2, β-Tubulin III) markers revealed the striking intertumor heterogeneity of primary GBM cell cultures. Upregulated expression of VIMENTIN, N-CADHERIN and CD44 at the mRNA/protein levels suggested increased epithelial-to-mesenchymal transition (EMT) in most studied cell cultures. The effects of temozolomide (TMZ) or doxorubicin (DOX) were tested in three GBM-derived cell cultures with different methylation status of the MGMT promoter. Amongst TMZ- or DOX-treated cultures, the strongest accumulation of the apoptotic markers caspase 7 and PARP were found in WG4 cells with methylated MGMT , suggesting that its methylation status predicts vulnerability to both drugs. As many GBM-derived cells showed high EGFR levels, we tested the effects of AG1478, an EGFR inhibitor, on downstream signaling pathways. AG1478 caused decreased levels of phospho-STAT3, and thus inhibition of active STAT3 augmented antitumor effects of DOX and TMZ in cells with methylated and intermediate status of MGMT . Altogether, our findings show that GBM-derived cell cultures mimic the considerable tumor heterogeneity, and that identifying patient-specific signaling vulnerabilities can assist in overcoming therapy resistance, by providing personalized combinatorial treatment recommendations.

High-grade gliomas (HGGs), the most common and aggressive primary brain tumors in adults, inevitably recur due to incomplete surgery or resistance to therapy. Intratumoral genomic and cellular heterogeneity of HGGs contributes to therapeutic resistance, recurrence, and poor clinical outcomes. Transcriptomic profiles of HGGs at recurrence have not been investigated in detail. Using targeted sequencing of cancer-related genes and transcriptomics, we identified single nucleotide variations, small insertions and deletions, copy number aberrations (CNAs), as well as gene expression changes and pathway deregulation in 16 pairs of primary and recurrent HGGs. Most of the somatic mutations identified in primary HGGs were not detected after relapse, suggesting a subclone substitution during the tumor progression. We found a novel frameshift insertion in the ZNF384 gene which may contribute to extracellular matrix remodeling. An inverse correlation of focal CNAs in EGFR and PTEN genes was detected. Transcriptomic analysis revealed downregulation of genes involved in messenger RNA splicing, cell cycle, and DNA repair, while genes related to interferon signaling and phosphatidylinositol (PI) metabolism are upregulated in secondary HGGs when compared to primary HGGs. In silico analysis of the tumor microenvironment identified M2 macrophages and immature dendritic cells as enriched in recurrent HGGs, suggesting a prominent immunosuppressive signature. Accumulation of those cells in recurrent HGGs was validated by immunostaining. Our findings point to a substantial transcriptomic deregulation and a pronounced infiltration of immature dendritic cells in recurrent HGG, which may impact the effectiveness of frontline immunotherapies in the GBM management. KEY MESSAGES: Most of the somatic mutations identified in primary HGGs were not detected after relapse. Focal CNAs in EGFR and PTEN genes are inversely correlated in primary and recurrent HGGs. Transcriptomic changes and distinct immune-related signatures characterize HGG recurrence. Recurrent HGGs are characterized by a prominent infiltration of immature dendritic and M2 macrophages.

Anti-tumour therapies eliminate proliferating tumour cells by induction of DNA damage, but genomic aberrations or transcriptional deregulation may limit responses to therapy. Glioblastoma (GBM) is a malignant brain tumour, which recurs inevitably due to chemo- and radio-resistance. Human RecQ helicases participate in DNA repair, responses to DNA damage and replication stress. We explored if a helicase RECQL4 contributes to gliomagenesis and responses to chemotherapy. We found upregulated RECQL4 expression in GBMs associated with poor survival of GBM patients. Increased levels of nuclear and cytosolic RECQL4 proteins were detected in GBMs on tissue arrays and in six glioma cell lines. RECQL4 was detected both in cytoplasm and mitochondria by Western blotting and immunofluorescence. RECQL4 depletion in glioma cells with siRNAs and CRISPR/Cas9 did not affect basal cell viability, slightly impaired DNA replication, but induced profound transcriptomic changes and increased chemosensitivity of glioma cells. Sphere cultures originated from RECQL4-depleted cells had reduced sphere forming capacity, stronger responded to temozolomide upregulating cell cycle inhibitors and pro-apoptotic proteins. RECQL4 deficiency affected mitochondrial network and reduced mitochondrial membrane polarization in LN18 glioblastoma cells. We demonstrate that targeting RECQL4 overexpressed in glioblastoma could be a new strategy to sensitize glioma cells to chemotherapeutics.

Background: Daily clinical practice shows us how diametrically different surgical outcomes can occur in particular groups of patients sharing the same diagnosis and being subjected to the same treatment. Patient-reported outcomes appear to be significantly influenced by social factors and patients' emotional status. Data on such variables were collated and analyzed statistically with the aim of confirming our clinical observations., Methods: We analyzed a group of 100 patients following cervical disc surgery. The clinical evaluation was based on a visual analog scale (VAS) for pain and the neck disability index (NDI). Non-clinical data comprised education status, employment status, body mass index (BMI), and history of depressive episodes in the period immediately preceding the surgery, which was investigated using the Beck Depression Inventory (BDI)., Results: Patients who had completed university or secondary school education had a significantly lower BMI and lower BDI scores and they reported less pain at 12 months postoperatively than patients with vocational or elementary school education only. Patients who were employed at the time of the study or were retired demonstrated significantly lower NDI scores both before the surgery and at 12 months postoperatively, as well as lower BDI scores compared to those who were unemployed or drew disability pensions. Factors such as age or BMI score did not exert a direct effect on treatment outcomes assessed as changes in the VAS and NDI scores., Conclusions: Surgical treatment for the cervical disc disease decreases pain and improves patients' quality of life. Treatment outcomes are also influenced by social factors and patients' emotional status.

We analysed 100 patients following anterior cervical discectomy and fusion with interbody stabilisation with PEEK cages. Radiographs obtained preoperatively and during the 12-month follow-up were compared to track changes in overall and local cervical lordosis and disk space height. Subsidence was defined as cage migration ≥ 3 mm into the adjacent endplates. Mean change in operated disk space height was 1.13 ± 1.33 mm. Subsidence was detected in 10.23% of the operated spaces. Mean change in overall cervical lordosis was 1.31 ± 5.71 degrees, and mean change in local lordosis was 0.19 ± 4.71 degrees. Change in overall cervical lordosis correlated with change in local lordosis (r = 0.61, p < 0.01). The greatest changes in lordosis and disk space height were noted immediately post-surgery. Baseline values were approximated gradually over time, but the post-operative values at 12 months were still higher than baseline. Disk space height change did not correlate with changes in patient-reported pain intensity at baseline (VAS 0) vs. at 12 months post-operatively (VAS 12) (r = 0.12, p < 0.05) or changes in the Neck Disability Index (NDI) at baseline (NDI 0) vs. at 12 months post-operatively (NDI 12) (r = -0.02, p = 0.05). Changes in overall cervical lordosis did not directly influence treatment outcomes assessed by comparing VAS 0 vs. VAS 12 (r = 0.13, p = 0.24) or NDI 0 vs. NDI 12 (r = -0.0005, p = 0.96). Surgical outcomes depend primarily on adequate decompression of the spinal cord and nerve roots. Post-operative radiological changes did not directly influence patients' pain level or quality of life., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Only a few reports have been published on the natural history of non-shunted patients suspected of having NPH. The aim of this study is to follow up a group of such cases., Methods: It was possible to follow up 27 patients who had not been qualified for shunting after the primary diagnosis. An assessment of Hakim's triad was performed, together with an analysis of radiological parameters and the results of lumbar infusion tests (LITs), both on admission and at the later date (on average, after 5.6 months). All parameters were analyzed with respect to periventricular lucency (PVL), atrophy, type of NPH, and the age of the patients., Results: There were no deteriorations and six patients improved. Those who were over 50 and who had no PVL or secondary NPH tended to improve more frequently. Significant improvement of dementia was noted (p = 0.042) in all cases, and in the group of patients without PVL (p = 0.04). The size of the ventricles did not change significantly. The values of the resistance to outflow (R), elastance (E), and ICP remained stable., Conclusions: Analysis of our series revealed that the patients suspected of having NPH who had not been qualified for shunting did not deteriorate, while some of them even improved significantly as far as the level of dementia was concerned. As the CT and LIT parameters remained stable, there were no indications for repeating these examinations, at least within the period of nearly 6 months, which followed the primary diagnosis.

Background: In patients with multiple myeloma (MM) there is a high risk of compression fractures of the spine. In the majority of cases, the method of treatment is percutaneous vertebroplasty (PV) or kyphoplasty (PK). The number of studies verifying their efficacy in MM is still relatively small., Objectives: The aim of this study has been to assess medium- and long-term pain relief as well as improvement in the quality of life (QL) after PV in MM cases., Material and Methods: There was a prospective group of 34 MM cases in which a total of 131 vertebral bodies were augmented by means of PV. It was possible to follow up 22 patients who agreed to take part in the assessment. Their level of daily activity and the level of pain were assessed using the Oswestry Back Pain scale and a visual analogue scale (VAS) before PV and at a later date (medium-term follow up was a mean of 10 months after the last operation). Five out of eight cases in which 4.5-5 years had elapsed since the first PV were tested again (long-term follow-up)., Results: Relief of pain and improvement of QL, assessed a mean of 10 months after PV, proved to be statistically significant. On the average, pain decreased by 4.7 points as measured on the VAS scale and the average improvement in the QL measured on the Oswestry scale was 27.7%. There were no neurological or general complications. After 4.5-5 years, there has not been any significant change in the level of pain relief or the improvement in the QL in the 5 cases in which long-term assessment was possible., Conclusions: In MM cases, PV is a simple, effective and safe method for the treatment of vertebral infiltration and compression fractures, giving permanent long-term pain relief and concomitant improvement in the QL.

Background: The problem of adequate diagnosis of hydrocephalus followed by administration of an effective treatment has not yet been properly solved. Specifically, this pertains to the decision about the surgical insertion of a flow diverting device., Aims: A lumbar infusion test was used to examine the compensatory parameters of intracranial space in giant hydrocephalus. The early and late results of shunt implantation were analyzed together with complications after surgery., Settings and Design: In-house software was used offline to adjust the dynamic intracranial pressure (ICP) response to infusion., Materials and Methods: Nine patients with giant hydrocephalus were the subjects for the study. We analyzed recordings of the response in ICP to the 2 ml/min infusion of saline. We performed computerized identification of outflow resistance and intracranial compliance based on the truncated (30- 100%) ICP response and assessed the stability of estimates over time. Eight out of nine patients were shunted. Monitoring of patients was followed for a period of up to 9 months., Results: Five out of eight shunted patients improved within a few days of surgery. During follow-up five patients developed various complications. A definite improvement was noted in four patients. The improvement rate did not correlate with any of the compensatory parameters. Most of the patients studied exhibited a lack of intracranial space reserve, a significantly reduced rate of CSF secretion, and a slightly elevated value of outflow resistance., Conclusions: The infusion test showed itself to be more useful as a way of revealing the compensatory parameters of the intracranial space than as a prognostic tool. The outcome of shunted patients with giant hydrocephalus was uncertain, owing to the relatively high rate of complications. We may therefore suggest that the diagnosis of giant hydrocephalus is a relative contraindication to implantation, as well as to the performance of an infusion test.

Background and Purpose: The main goal of the present study is to examine compensatory parameters of intracranial space in giant hydrocephalus. We also assess the early and late outcome and analyse complications in shunted cases., Material and Methods: Nine cases of giant hydrocephalus characterised by the value of Evans ratio > 0.5, ventricular index > 1.5, and the width of the third ventricle > 20 mm were considered. Using the lumbar infusion test and developed software we analysed the intracranial compensatory parameters typical for hydrocephalus. Based on the Marmarou model, the method depended on a repeated search for the best fitting curve corresponding to the progress of the test was used. Eight out of nine patients were therefore shunted. Patients were followed up for 9 months., Results: Five out of eight shunted patients undoubtedly improved in a few days after surgery (62%). Complications (subdural hygromas/haematomas and intracerebral haematoma) developed in 5 (62%) cases in longer follow-up. A definite improvement was noted in 4 out of 8 operated cases (50%)., Conclusions: To get the stable values of compensatory parameters, the duration of the infusion test must at least double the inflexion time of the test curve. All but one considered cases of giant hydrocephalus were characterized by lack of intracranial space reserve, significantly reduced rate of CSF secretion and by various degrees of elevated value of the resistance to outflow. Due to the significant number of complications and uncertain long-term improvement, great caution in decision making for shunting has to be taken.

Objective: Glioma cells can produce anti-inflammatory cytokines such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) which inhibit T cell and monocyte function. It is unknown if production of these cytokines is limited to the site of tumor or these molecules are also released to cerebrospinal fluid and blood. The goal of our study was to determine if patients with astrocytoma have increased levels of IL-10 and TGF-beta 2 in cerebrospinal fluid (CSF) and serum., Methods: CSF and serum samples were taken from 16 patients with astrocytoma of grade III or grade IV according to the WHO classification and from 28 age- and gender-matched controls (patients with normal pressure hydrocephalus or with lumbar disk herniation). Cytokine concentrations were measured using ELISA methods., Results and Discussion: There was no difference in serum levels of IL-10 and TGF-beta 2 between groups. Patients with astrocytoma had decreased levels of IL-10 (0.9 +/- 1.2 versus 3.5 +/- 9.2 pg/ml, p=0.01) and TGF-beta 2 (0.0 +/- 0.0 versus 5.4 +/- 9.4 pg/ml, p=0.05) in CSF compared to controls. Because serum IL-10 and TGF-beta 2 levels are similar in patients with astrocytoma and in controls, these cytokines are probably not directly involved in peripheral monocyte and T cell deactivation.

Background and Purpose: The aim of the study was to evaluate selected markers of thrombin generation and subsequent fibrinolysis in patients with aneurysmal subarachnoid haemorrhage (SAH) and to assess the relationship between thrombin generation/fibrinolysis and clinical course and outcome., Material and Methods: This prospective study included 72 patients after aneurysmal SAH who underwent surgery within 72 hours after onset of symptoms. The results were compared with 84 control patients without SAH. Selected markers of thrombin generation (thrombin-antithrombin complexes, TAT), fibrinolysis (D-dimer) and fibrinogen level were examined in blood just after admission and on day 7 after surgery. The relationship between levels of those markers and selected clinical and radiological data, and outcome at 3-6 months after surgery, were assessed., Results: On admission, patients with SAH had higher levels of TAT (p<0.001), D-dimer (p=0.048), and fibrinogen than the control group (p<0.001). Also, patients with severe bleeding demonstrated higher TAT (p<0.001) and D-dimer (p=0.04) levels. The admission level of TAT (higher than 24 g/l; odds ratio = 10.8) and the elevated blood fibrinogen level (odds ratio = 1.2) showed a strong correlation with mortality. Furthermore, a level of TAT higher than 24 g/l (odds ratio = 9.98) and the level of fibrinogen (odds ratio = 1.3) strongly correlated with poor outcome. There was no significant correlation between markers of coagulation on the 7th day after surgery for SAH and the outcome., Conclusions: Activation of blood coagulation as well as the fibrinolytic system occurred early in the course of SAH. Such activation was associated with poor clinical status of patients on admission, greater amount of subarachnoid blood, and poor clinical outcome. Thus, blood levels of TAT and fibrinogen are independent factors associated with mortality and morbidity after aneurysmal SAH.

Introduction: Stereotactic biopsy is unquestionably regarded as the gold standard for histopathological diagnosis of surgically inaccessible tumors. Tissue samples can be obtained by minimally invasive technique. Histopathological examination opens the door to oncological treatment of patients. Such procedures have been performed in the Neurosurgery Department, Jagiellonian University in Krakow since February 2003. The aim of this study is to evaluate the use of "P.N." type Frame (Tatramed, Slovakia) in verification of surgically inaccessible tumors., Material and Methods: Surgically inaccessible diffuse, deep-seated or located in eloquent areas tumors of cerebral hemispheres were diagnosed in 36 patients. In these cases 56 stereotactic biopsies were performed. The specimens of tumors were obtained with the aspiration method, according to coordinates derived from CT scan. The procedure was performed under local anesthesia in 17 patients and in 19 cases, it was performed under general anesthesia. The lesion was located in 13 cases in cerebral hemisphere infiltrating basal ganglia, in 13 cases tumors were diffused within one of the hemisphere but without involvement of basal ganglia, in 7 cases tumors were localized in eloquent areas, in 1 case in posterior commissure, in 1 case it was a tumor of corpus callosum and third-ventricle and in 1 case a tumor was multifocal., Results: Material from the stereotactic biopsy has been examined neuropathologically. Astrocytomas II degree WHO were diagnosed in 8 cases, Astrocytomas III degree WHO in 12 cases, and Astrocytomas IV degree WHO in 10 cases. Metastatic Adenocarcinoma was diagnosed in 3 cases and in 3 cases a neoplasm was not found. The definite histopathological diagnosis was confirmed (in relation to the "intraoperational" one) in 91.7%. In 3 cases the increased intracranial pressure produced by tumor cyst was reduced by the use of biopsy. Patients with gliomas of III degree and IV degree WHO were treated by irradiation. Stereotactic biopsy in 11 cases (that is 44% of all cases) made the oncological treatment possible., Conclusions: Stereotactic biopsy with the use of "P.N." type frame is a very safe and precise method making the histopathological diagnosis of inaccessible tumors possible. The size of tissue sample acquired with the use of "P.N." frame makes the use of standard histopathological techniques possible. Stereotactic diagnosis of some tumors made oncological treatment possible whenever there were no contraindications for the adjuvant treatment.

Background and Purpose: Most arachnoid cysts (ACs) are asymptomatic, but some of them cause mass effect, mainly in adults. Surgery of ACs is controversial, especially regarding the choice of the best method of treatment. The authors present short- and long-term outcome of endoscopic surgery of ACs., Materials and Methods: There were 19 adults with symptomatic ACs treated surgically in the last 6 years. 16 cysts were located supratentorially, and 3 infratentorially. Cystocisternostomy was carried out in 7 patients, cystocisternostomy with catheter implantation was performed in 5 patients, cystoventriculostomy in 3 patients, and cystoventriculostomy with catheter implantation was carried out in 2 patients. In one case additional endoscopy combined with shunt was necessary, and in another one endoscopy converted to microsurgery. Outcome was assessed by means of neurological examination and computed tomography (CT)., Results: During the short-term follow-up, 11 (57.9%) cases improved neurologically, and in 6 (33.0%) ACs were significantly smaller in CT. During the long-term follow-up, 14 (73.7%) patients improved significantly, and the size of ACs was reduced in 16 (84.2%). In two cases subdural haematoma was observed., Conclusions: Outcome after endoscopic surgery of ACs in adults is good, and the complication rate is low. Endoscopy should be recommended as the treatment of choice in patients suffering from ACs.

Unlabelled: Among all detected cerebral angiomas the frequency of cavernous angiomas (CAs) is 5-13%. The aim of this study is to present the diagnostic methods of CA of the central nervous system (CNS), indications for surgery and assessment of its outcome. Between 1993-2000, eleven cases of CAs were operated on at the Department of Neurosurgery, Medical College, Jagiellonian University in Krakow. In 6--seizures were observed, in 4--headache (supratentorial CAs), increasing neurological deficits in 4 (location in vertebral channel and cerebellum), hemorrhage--1 case (CA in pons combined with supratentorial lesion). Surgery was carried out by means of craniotomy, and via laminectomy in the cases of spinal channel tumours. Early and late outcome were assessed in following cathegories: very good, good, fair, bad (significant deterioration). The shortest late observation was 5 years. Direct very good surgical outcome was attained in 4 cases (36%), good in 4. (36%), fair in 2. (18%), bad in 1 case. In late observation, 7 patients were very good (64%), and 3 good (27%). In one case the neurological improvement was poor, later observed--late outcome was fair. In 6 cases they suffered from frequent epileptic seizures before surgery; they were seizure free in the late assessment., Conclusions: (1) direct surgical outcome in CA of the CNS is good and very good in the majority of cases; (2) in late observation, further neurological improvement allows to attain over 90% good and very good outcomes; (3) the high antiepileptic effectiveness after surgery of CA is observed.

Intracerebral haematoma (ICH) distantly from the site of insertion of a ventriculoperitoneal shunt or external drain is an extremely rare complication. In contrast to ICH caused by disruption of small cerebral vessels by the catheter, the cause of haematoma distantly from the shunt is unclear. We report three cases of ICH occurring distantly from the tubing path. We also discuss possible mechanisms and provide a literature review of this complication.

Unlabelled: The transsphenoidal pituitary tumors surgery is often connected with intraoperative rhinorrhea. This complication might be serious if occurs again in the postoperative period. The aim of this study is to evaluate the sella reconstruction methods in patients with intraoperative rhinorrhea and comparing of their efficiency., Material and Methods: In the group of 259 consecutive cases operated on at the Neurosurgery Department in Cracow using the transsphenoidal approach, in 40 occured intraoperatively observed rhinorrhea. In the 26 cases we used Surgicel, artificial dura or fascia and Tissucol (I group), and in 14 TachoComb with Tissucol but in 5 also fascia or artificial dura (II group)., Results: Out of the 26 patients from the I group (without TachoComb) in 5 cases occurred postoperatively rhinorrhea (3-36 days after surgery). 4 patients were reoperated, 1 patient died due to the meningitis. 2 patients suffered from the visual disturbances due to the sella overpacking (7,7%), what was visualized in the control imaging studies. In 14 cases from the II group in 2 postoperative rhinorrhea was observed (in the 7 and the 30 day after operation)--14,2%. There were no signs of meningitis, and no fatal cases. The visual disturbances as well as overpacking of the sella were not observed., Conclusions: Using of the TachoComb in reconstructive surgery of the sella reduces the risk of the post operative CSF leak and eliminates the features of the sella overpacking and visual deterioration.

A case of GH and TSH secreting pituitary macroadenoma is reported. A 45-year-old female presented clinical features of acromegaly (the abnormal growth of the hands and feet, with lower jaw protrusion), diabetes mellitus, hypertension, nodular goiter and hyperthyroidism of unclear origin. NMR pituitary imaging revealed intra and extrasellar tumor. The laboratory examinations showed very high plasma levels of GH and IGF-1 and normal level of TSH coexisting with high plasma levels of free thyroid hormones. Pharmacological pretreatment with somatostatin analogues caused the substantial reduction of GH and TSH plasma levels. Histological and immunohistochemical examination of the tissue obtained at transsphenoidal surgery showed GH and TSH secreting adenoma. The laboratory examinations after surgery showed normal GH and IGF-1 plasma levels and reduced insulin requirement, what indicates radical operation. The very low plasma levels of TSH and free thyroid hormones after surgery and immunohistochemical examination suggest central hyperthyroidism due to TSH secreting pituitary tumor (thyrotropinoma).

Background and Purpose: Aggressive surgery for parasagittal meningiomas is considered when superior sagittal sinus is totally thrombosed by the tumour. However, there is potential risk of venous outflow injury resulting in an intracerebral haemorrhage. The aim of this study is to present surgical technique and early surgical outcome of patients with meningiomas obliterating the superior sagittal sinus., Material and Methods: Ten patients (4 men and 6 women, mean age 58), operated for sagittal meningiomas with radiologically proved superior sagittal sinus obliteration, were analysed retrospectively. In all cases, radical surgery with the resection of invaded sagittal sinus was performed. The size of tumours varied between 35 and 100 mm; the mean was 53 mm. Five of them required reoperation because of tumour recurrence due to a previous incomplete resection. In five cases, bifrontal craniotomy was made, in four biparietal and in one parieto-occipital. Preoperative status and direct postoperative outcome were compared using the Karnofsky scale., Results: Very good outcome was achieved in 6 cases--the clinical status remained unchanged. In two, the outcome was good (in the first patient hemiparesis increased and in the second there was worsening of cortical visual disturbances). In two cases with an unfavorable outcome, one patient suffered quadriparesis and mutism; the other experienced cerebral edema with hemorrhagic infarct and died despite decompressive surgery. Both these patients were totally dependent before surgery (Karnofsky < 40)., Conclusions: In the radical resection of a tumour with occluded sinus, direct postoperative outcome ranges from good to very good in a significant number of cases. In dependent patients having a large tumour, there is the risk of an unfavourable outcome after radical surgery. In such cases, partial resection and further radiotherapy should be considered.

Pneumocephalus in hydrocephalic shunted patients is very rare. So far only 46 cases have been described in the literature. A case of pneumocephalus in a patient with shunted hydrocephalus, and the diagnostic and therapeutic problems were described. A 38-year-old woman suffered from a subacute headache, dizziness and bradyphrenia. Eight years ago, the ventriculo-atrial shunt was implanted due to idiopathic hydrocephalus, and the shunt was changed 2 months before the present admission (ventriculo-peritoneal valve). CT and MRI revealed pneumocephalus, but neither clinical nor radiological symptoms of the CSF fistula were found. After temporary ligation of a distal catheter, the anterior fossa and a sellar area were directly repaired via right fronto-temporal craniotomy, with a good outcome. In the case of pneumocephalus in hydrocephalic shunted patients, the direct closure of the skull base fistula via craniotomy combined with restoration of the proper shunt function is usually the most effective treatment. If the site of the fistula can not be established, dural cranioplasty in the most likely site of the fistula is recommended.

Aim: Proximal anterior cerebral artery (A1) aneurysms are considered to be rare or even unique. Proper surgical planning around A1 segment is particularly essential in order to avoid injury of tiny perforating arteries., Methods: In 17 patients with angiographically or intraoperatively diagnosed A1 aneurysms, representing 0.8% of 2 124 aneurysm patients treated surgically at our institution between 1991 and 2003, clinical presentation, neuroradiological findings, surgical treatment methods and outcome were retrospectively analyzed., Results: Sixteen patients presented with subarachnoid hemorrhage; A1 aneurysms were ruptured in 13 cases. Five patients (29%) had multiple aneurysms. In all cases A1 aneurysms were saccular and their maximum diameter ranged from 4 to 25 mm, average, 7.2 mm; in 4 cases they projected from the origin of the perforating artery, in 6 at the bifurcation of the internal carotid artery, in 5 at the anterior communicating artery and in 2 from the convexity of the parent artery. In 15 patients aneurysms were clipped via ipsilateral pterional approach and in the remaining 2, including a case with a second middle cerebral artery aneurysm, through contralateral approach. Eleven patients had excellent outcome, three good, and three died., Conclusions: Angiograms must be thoroughly analyzed to correctly assess origin of the aneurysmal neck, and to plan the operative procedure as radiological presentations of distal or proximal A1 lesions resemble those of anterior communicating artery and internal carotid artery bifurcation aneurysms, respectively. Contralateral approach may facilitate surgical elimination of selected A1 aneurysms or enable one-stage clipping in patients with multiple bilateral aneurysms.

Object: Data concerning an association between the ENG gene intronic insertion polymorphism and intracrahial aneurysms (IAs) remain inconsistent. In this study the authors investigated whether this polymorphism is associated with a subarachnoid hemorrhage (SAH) caused by a ruptured IA in a Polish population., Methods: One hundred nineteen patients with aneurysmal SAH and 119 sex-matched healthy volunteers were studied. The insertion ENG gene polymorphism in intron 7 was identified using polymerase chain reaction-single-strand chain polymorphism method. The distribution of the insertion allele did not differ between the SAH (13%) and control (16%) cases (p = 0.36). The homozygous insertion/insertion genotype frequencies in these cases were 3.4 and 0.8%, respectively (p = 0.18)., Conclusions: The authors failed to find an association between the intronic insertion polymorphism of the ENG gene and aneurysmal SAH in a Polish population.

Background and Purpose: The member 3 of clade A of serine proteinase inhibitors (SERPINA3), known previously as the alpha1-antichymotrypsin, is an acute phase protein, the levels of which increase in acute and chronic inflammation. The A/T polymorphism of the SERPINA3 gene influences expression of SERPINA3 protein. SERPINA3 can be related to aneurysmal subarachnoid hemorrhage (SAH) by influencing inflammation or by regulating cathepsin G activity. We studied the significance of SERPINA3 A/T polymorphism in patients with aneurysmal SAH compared with healthy controls., Methods: A total of 180 patients with aneurysmal SAH and 263 healthy controls were genotyped for the SERPINA3 A/T polymorphism. Aneurysmal SAH was diagnosed by cranial computed tomography or lumbar puncture and digital subtraction angiography. SERPINA3 polymorphism was detected by polymerase chain reaction amplification and restriction enzyme digestion., Results: The SERPINA3 genotype distribution in patients with aneurysmal SAH (AA-29 16.1%; AT-108 60.0%; TT-43 23.9%) differed significantly from controls (AA-70 26.6%; AT-123 46.8%; TT-70 26.6%; P=0.009). A logistic regression model showed that the presence of genotype with T allele (AT+TT; odds ratio [OR], 2.01; 95% CI, 1.19 to 3.38; P=0.009) or AA genotype (OR, 0.49; 95% CI, 0.30 to 0.84; P=0.009) of the SERPINA3 influences the risk for aneurysmal SAH independently from smoking, excessive alcohol consumption, and hypertension., Conclusions: The A/T polymorphism of SERPINA3 gene is associated with the risk factor for aneurysmal SAH.

Background and Purpose: Because of their deep location, intra- and para- ventricular brain tumors pose an important therapeutic issue. Technical difficulties during the operation often result from the alteration of anatomy produced by the tumor, which brings about the risk of injury to functionally important structures. The authors assess clinical usefulness of neuroendoscopy in the treatment of discussed tumors., Material and Methods: Medical records of 16 adult patients treated between 2000 and 2003 were analyzed. The diagnosis was based on CT with 3D reconstruction and MRI. In 7 cases the tumor was located in the third ventricle, in 4--in lateral ventricles, in 5--paraventricularly. Surgery was performed using a rigid neuroendoscope and/or neurofiberscope equipped with the basic set of endoscopic instruments. The efficacy of the procedure was evaluated by clinical, CT and MRI follow-up examinations. The intended and achieved aim of the operation as well as the remote outcome were analyzed., Results: The planned aim of the procedure was achieved in 12 (75%) patients. In 3 cases the tumor was removed totally, in 5--tumor mass was reduced restoring the cerebro-spinal fluid passage, in 4--tumor biopsy was performed. In 4 patients different obstacles made it impossible to achieve the intended aim of the procedure. 1 patient died in the direct postoperative course. In the long-term postoperative follow-up ranging from 8 to 44 months (median: 23 months), the clinical condition improved or was stable in 10 patients, 2 patients were reoperated, 2 became dependent and 1 was lost for follow-up., Conclusions: Neuroendoscopy offers new options in the treatment of intraventricular and paraventricular brain tumors allowing for their removal, reduction, histopathological verification and restoration of the cerebrospinal fluid passage. The outcome is good with a low complication rate.

Aim: To compare craniotomy and clip application with endovascular coiling in patients with posterior circulation aneurysms., Material and Methods: Among 676 consecutive patients with aneurysmal SAH who had been treated with either clipping or coiling, a group of 46 patients with aneurysms in the posterior circulation (32 treated surgically and 14 endovascularly) were selected for further investigation. Patient and aneurysm characteristics, procedural complications, and clinical and radiological results were compared retrospectively. The odds ratio for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for preoperative clinical condition parameters was assessed by logistic regression analysis. The group was not randomized., Results: In the endovascular group 6 patients (42.9%) had a poor outcome vs. 8 (25%) in the surgical group; the adjusted odds ratio for poor outcome after coiling vs. clipping was 3.21 (p = NS). The observed difference in outcome was consequent on higher incidence of severe neurological deficit (GOS 3) after embolisation, compared with clip application (26% and 9.4% of patients respectively); mortality was comparable in both groups (14.3% vs. 15.6%). Optimal or suboptimal aneurysm occlusion immediately after coiling was achieved in 12 patients (85.7%). Clipping was successful in 31 patients (96.9%)., Conclusion: There was no statistically significant difference in outcome between the two treatment groups. However, patients were less likely to be dependent when treated by craniotomy and clip application, compared with endovascular MDS embolisation.

Objectives: To describe computer system for intracranial pressure (ICP) monitoring and for infusion testing (IT), and to present current possibilities of analysis of cerebrospinal fluid (CSF) pressure signal., System Description: Computer system for pressure signal measurement and acquisition consists of three sensors: for ICP, infusion pressure during IT, and blood pressure measurements. Electric signal from the sensors is transmitted to Temed RMN-201M cardiomonitor, and next after enhancement is subjected to Data Shuttle DS-12-8-5B-AO analog to digital converter. Digital output signal is recorded and analysed'on standard personal computer. Original Windows-compatible software was developed to control the system. The program consists of three blocs: configuration, measurement and readout, and enables selection of voltage range for each of the signal channels, measurement resolution, sampling frequency, calibration and zeroing of the sensors, visualisation of pressure signals on graph, data storage in text format and automatic analysis of IT. Main characteristics of the system include: high sampling frequency (up to 500 Hz), simultaneous data recording from all signal channels, and access to terminal cistern with one puncture needle on IT. Laboratory and clinical tests confirmed high precision of the developed system. ICP CURVE ANALYSIS: The developed software allows for evaluation of the main parameters, of CSF dynamics, prediction of IT course before a steady state is reached as well as spectral analysis of pressure signal., Conclusions: Computer measurement system developed at our department is clinically useful and allows for high precision signal acquisition necessary for advanced scientific analyses of hydrocephalus and intracranial pressure.

The filling of the cranial defect is an essential problem in neurosurgery on account of the necessity of brain protection as well as for cosmetic reasons. The aim of this study was to evaluate the direct and distant outcome after polypropylene-polyester Codubix prosthesis implantation. This research was based on the analysis of 41 patients treated surgically in the Department of Neurosurgery at the Jagiellonian University in Cracow between 1995-2004. All patients had the Codubix prosthesis implanted. The implantation was performed either synchronously or after the surgery which caused the cranial defect. Directly after the surgery proper healing of the prosthesis could be observed in all patients. The exception was one patient who died directly after the surgery but the cause of his death was not connected with the prosthesis implantation. Seven patients (17,1%) had the temperature temporarily elevated. Three had haematoma collection in the subgaleal space, one (2,4%) developed meningitis which was successfully treated with antibiotics, one (2,4%) suffered from temporary circulation disturbances of the scalp. The late evaluation was performed with help of a questionnaire to which 30 patients (73,2%) responded. The answer ranged 73,2% (30 patients). In this group 16 patients (53,4%) described the cosmetic effect as very good, 10 patients (33%) as good and 4 (13,3%) as unsatisfactory. The commonest reason for the critical note was the depression of the plate which happened to 3 patients. The other 3 patients complained about inappropriate profile of the plate causing the asymmetry of the cranial vault. Seven patients felt temporary pain in the postoperative scar, in one case the pain was took as the friction between the prosthesis and bone margin. Properly performed implantation of accurate bone prosthesis Codubix is safe and usually brings a good cosmetic effect. Direct complications are transitional and occur in the small percent of cases. Distant examinations show generally good therapeutic results but implanted Codubix requires suitable shape and careful fixation.

Background and Purpose: Surgical evacuation of spontaneous intracerebral hematomas (ICH) performed in a traditional way usually increases primary brain tissue damage due to the hemorrhage. On the other hand, symptoms of the intracerebral pressure and secondary brain tissue destruction close to the hematoma are the basis for making a decision about surgical treatment. In order to limit surgical trauma we started research to evaluate the usefulness of endoscopic surgery in the treatment of ICH., Material and Methods: Twenty three cases were included in the study. Patients with consciousness disorders and/or focal neurological deficit and different systemic diseases were qualified for endoscopic evacuation. The diagnosis of hematoma was based on computed tomography (CT). ICHs were lobar and in certain cases they extended to the basal ganglia. All patients were operated on within one week from the onset of symptoms. Neuroendoscope was introduced to the hematoma cavity through the burr hole and the puncture of the cerebral surface over the hematoma. The hematoma was evacuated by fractionated rinsing. Bigger clots were fragmentized but those which were adjacent to the cavity wall were left. Postoperative assessment of the hematoma evacuation was based on CT performed immediately and in the second week after surgery., Results: Total evacuation of the ICH was achieved in 6 patients, and its volume was reduced in 17 cases. Symptoms of brain edema resolved in all patients. A significant trend to reduce focal neurological deficits was observed: 16 patients improved and 3 remained unchanged. Four patients died., Conclusions: Endoscopic surgery allows a complete hematoma evacuation or reduction of its volume, reduces symptoms of brain edema and accelerates the improvement of focal neurological deficits.

Background and Purpose: Evidence exists in support of a role of genetic factors in susceptibility to aneurysmal subarachnoid hemorrhage (SAH) in humans. Meta-analysis of 2 previous studies showed that the I allele of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism was a weak, but significant, risk factor for aneurysmal SAH. Moreover, a recent study has shown that the local renin-angiotensin system (RAS) is involved in the development of intracranial aneurysm. The aim of this study was to investigate the association between ACE I/D polymorphism and a risk for aneurysmal SAH in a Polish population., Methods: Ninety patients with aneurysmal SAH (mean age: 48.9+/-14.0 years) and 128 healthy controls matched for age and sex were genotyped for the ACE I/D polymorphism. Aneurysmal SAH was diagnosed by cranial computed tomography and/or lumbar puncture and digital subtraction angiography. ACE gene polymorphism was detected by polymerase chain reaction amplification of the intron 16-specific I/D fragments, 490-bp and 190-bp, respectively., Results: The ACE genotype distribution in patients with aneurysmal SAH (II, 52.2%; ID, 15.6%; DD, 32.2%) differed significantly from controls (II, 23.4%; ID, 50.8%; DD, 25.8%) (P<0.001). A logistic regression model showed that the II genotype of ACE gene was independent from female sex and smoking as a risk factor for aneurysmal SAH (OR, 4.57; 95% CI, 2.35 to 8.90)., Conclusions: Here we report that II genotype of ACE gene is a risk factor for aneurysmal SAH.

Background and Purpose: Lumbar infusion test (IT) is still one of the most important diagnostic tools in the communicating hydrocephalus. On one hand suitability of parameters achieved during tests is being highlighted, while on the other hand benefits are being questioned due to the test invasiveness. The aim of this paper is to assess the possibility of reducing the duration of IT. The study was based on a theoretical model and the analysis of selected IT performed in patients suffering from normal pressure hydrocephalus., Material and Methods: Theoretical principles of the volume-pressure compensation in hydrocephalic patients are considered. Then, based on selected infusion test, an analysis of the data was carried out using the mathematical model. Finally the methods of IT optimization were proposed., Results: The analysis of IT should be performed in dynamic (not static) conditions. For the proper assessment of the IT the classical Marmarou's model is sufficient. This model interposed on the normal IT curve helps avoid too short and too long time of the IT. From a theoretical point of view it is impossible to minimize the duration of the IT by changing the infusion rate. This is due to the fact that formal relationships are characterized by curves with a single maximum, but not a minimum. The proposed algorithm for predicting the level of the steady state pressure, based on the initial course of the IT curve, allows for about 30% reduction of the IT time. The predictive error for the pressure value is less than 10%.

We present a case of bilateral hematoma in cerebellar hemispheres in a 30-year-old man after surgical treatment of extensive left frontal glioma. 16 hours after surgery the patient lost consciousness. An immediate CT revealed hematoma in both cerebellar hemispheres. The hematoma was subsequently removed via bilateral suboccipital craniectomy. After the operation the clinical status of the patient gradually improved - he was discharged in a good general condition. In the presented case the hematoma developed presumably as a consequence of extensive cerebrospinal fluid (CSF) loss (670 ml) via postoperative wound drainage. The resulting cerebellar displacement caused strain of the draining veins, affecting blood outflow, and causing parenchymal hemorrhage. In order to prevent the complication, massive CSF loss during and after operation should be avoided. Careful monitoring of the patient's condition in the postoperative period, even if the general status is good, is important because only an immediate intervention may prevent the development of irreversible consequences of cerebellar hematoma formation.

Introduction: Epileptic seizures as the only or one of the symptoms of a brain tumor are useful for prognostication and represent a factor influencing survival rate and quality of life in patients with high-grade and low-grade gliomas., Materials and Method: A retrospective analysis of 189 patients was carried out between 1981 and 1997. The shortest follow-up period was 2 years, the longest 8 years. Epileptic seizures were present in 43% of the patients before operation. Correlations between localization of glioma and type of seizure were studied. The Statistica software was used to analyze histopathology findings according to seizure frequency and its influence on survival rate., Results: Survival rates in patients with low-grade glioma (WHO II) and high-grade glioma (WHO III) suffering from seizures before operation were higher (p = 0.0306) than in patients without seizures. This relationship did not apply to WHO IV gliomas. There was no association between seizure frequency and histological type of tumor., Conclusion: Simple partial seizures are usually associated with low-grade supratentorial gliomas, whereas generalized seizures were present in high-grade gliomas.

Introduction: Distal anterior cerebral artery aneurysms (DACAA) are the particular group of the aneurysms of anterior circle of Willis. The characteristic factors are: different location on the distal anterior cerebral artery, specific surgical approach and rare occurrence., Aim: Retrospective analysis of the outcome and attempt to find risk factors in DACAA surgical treatment were goals of this report., Material and Method: The authors report a series of 49 cases with DACAA who were operated on in the Department of Neurosurgery, Jagiellonian University in Kraków, in the period of 16 years. There were 29 women (59.2%) and 20 men (40.8%) with a mean age of 49 years. Multiple aneurysm were in 12 cases (24.5%), in which ruptured DACAA were always the cause of the haemorrhage. We investigated age, sex, Hunt and Hess grade, arterial hypertension, timing of operation, coexistence of intracerebral haematoma (ICH), intraventricular haemorrhage (IVH), cerebral ischaemia, hydrocephalus, multiple aneurysms, intraoperative aneurysmal rupture, use of temporary parent vessel clipping, significant brain oedema during surgery, anatomical variability of anterior cerebral artery as a potential risk factors., Results: There were 29 patients (59.2%) in good and very good clinical state and 11 (22.4%) in poor clinical state on discharge. Nine (18.4%) patients died. Statistically significant factors such as age (p<0.035), arterial hypertension (p<0.0035), Hunt and Hess grade (p<0.0073), IVH (p<0.0054), cerebral ischaemia (p<0.036) affected the direct outcome of patients., Conclusions: There are typical risk factors in surgically treated DACAA: age, arterial hypertension, clinical status, intraventricular haemorrhage, cerebral ischemia. Most of treated cases remain in good and very good condition. Haemorrhagic and ischaemic complications were most frequent causes of operating losses in DACAA patients.

Introduction: Multiple aneurysms of the brain are a more dangerous disorder than single aneurysms. Most of patients have evidence of aneurysmal rupture, but rebleeding remains an additional danger because of co-existing aneurysms. These "silent" aneurysms also have to be operated--the risk of following subarachnoid haemorrhage (SAH) is about 2% annually., Aim: The purpose of this study was to assess of the surgical outcome in multiple aneurysmal SAH in regard to chosen risk factors., Material and Method: Retrospective analysis of 608 patients treated within three years (2001-2003) for cerebral aneurysms in the Department of Neurosurgery, Jagiellonian University in Kraków, was carried out. 14% patients had multiple aneurysms: 72--two aneurysms, 10 patients three aneurysms, and three patients four and more. The mean age was 50, with slight predominance of women (58%). Most patients were operated on via pterional craniotomy, and posterior circulation aneurysms were clipped by means of suboccipital approach. "Silent" aneurysms being clipped in the first stage, if were available via the same craniotomy, another--in the next stage. We analyzed short-term outcome of multiple aneurysms in comparison to the single (literature data). We presented the outcome (according to the Glasgow Outcome Scale) with regard to preoperative condition, age, location of the most frequent "bleeding" aneurysms (middle cerebral artery, anterior communicating artery), and in patients operated on in the 1st and 2nd stage. Accuracy of the preoperative detection of "bleeding" aneurysm was checked based on CT, MRI, angio-CT, angio-MRI and DSA., Results and Conclusions: Out of all 85 treated patients, 64 (75.3%) presented very good and good condition on discharge. Five (5.9%) were severe disabled, and 16 (18.8%) died. Good preoperative condition, age less than 55, and "bleeding" aneurysms of the middle cerebral artery (compared with anterior communicating artery) are good prognostic factors in surgically treated multiple aneurysms. Outcome in single and multiple aneurysms is similar, excluding perioperative losses, which are 5% higher in the multiple aneurysms group. In our series in each case of "bleeding" aneurysm was correctly detected preoperatively.

We describe a patient with a congenital neurenteric cyst located in the upper thoracic region of the spinal cord. Corrective surgery was performed but total excision was not possible due to the cyst's location. The patient remained asymptomatic during a 10-year follow-up, leading a normal life despite recurrence of the cyst.

Background: Stereotactic biopsy represents the gold standard for tissue diagnosis surgically inaccessible gliomas, tumors and cystic lesions. Tissue samples can be obtained by minimally invasive technique. Moreover, the combination of the neuro-endoscope with stereotactic method is possible., Material and Method: 23 patients underwent 43 stereotactic biopsy procedures for diagnosis diffuse, deep-seated and eloquent site tumors at Neurosurgery Department Jagiellonian University in Krakow since February 2003. Stereotactic frame "P.N." type (TatraMed S.r.o.) was used. In one case the combined method was used for third ventriculostomy. The specimen was obtained from the target point of CT scan by the aspiration method under local anesthesia in 17 patients and under general anesthesia in 6 patients. The lesion was located in 9 cases of cerebral hemisphere and basal ganglia, in 8 cases of spreading site, in 5 cases of eloquent area and in 1 case of corpus callosum and third-ventricle., Results: Material from the stereotactic biopsy has been examined neuropathologically. Astrocytoma II(o) WHO were diagnosed in 6 cases, Astrocytoma III(o) WHO in 11 cases, Astrocytoma IV(o) WHO in 3 cases, Metastatic adenocarcinoma in 1 case and in 2 cases the neoplasm was not found. The diagnosis was histologically confirmed in 91.3%. Emergency craniotomy was performed in one patient. In 3 cases the increased intracranial pressure produced by tumor cysts was reduced by the use of biopsy., Conclusions: Our data confirm that the "P.N." frame is useful in stereotactic biopsies and operations even with the use of neuroendoscope. The procedure is safe, easy to follow as a tool for patients with various tumors.

We showed case of subarachnoid hemorrhage with massive intracerebral hematoma of the left hemisphere and associating gastric myoelectrical disturbances. The cerebral angiography did not show vascular malformation. The electrogastrogram (EGG) at 2 days after the onset of neurological symptoms revealed tachygastria up to 66.7% of the recording time.

The etiology of cerebral hemorrhage is not always easy to diagnose and modern neuroimaging methods may be deceptive. The authors report on a 48-year-old previously healthy male admitted to hospital with a first-time severe generalized epileptic seizure. The patient presented with aphasia, confusion, headaches, nausea, right hemianopia and early papilledema. CT revealed an intracerebral hematoma in the left occipital lobe but MRI and MRA failed to provide any further insight into the etiology of the hemorrhage. Due to persisting intracranial hypertension, the patient underwent neuroendoscopic removal of the hematoma. After blood clots were evacuated, pathologic vascularity was found. Tissue samples were collected from the walls of the hematoma cavity. Neoplastic cells adjacent to the blood vessels were identified in one of the samples. The patient was reoperated and a glioma-like tumor was removed. The diagnosis of cerebral intratumoral hemorrhage is difficult especially when there are no previous clinical signs of a tumor. Neuroendoscopy may speed up the diagnostic process which usually extends past resorption of the haematoma and the technique may be an alternative to stereotactic surgery.

A case is presented of a 38-year-old female patient who developed bifocal metachronous cerebral glioma with the same histological appearance (glioblastoma multiforme). Two separate tumors were operated on within six months: the first one was localized in the left parieto-occipital area, and the other in the right temporal lobe. The tumor cells dissemination occurred probably via the CSF pathways: during the first operation the posterior horn of the left lateral ventricle was opened, and the second neoplastic lesion was situated also in the direct vicinity of CSF spaces (the Sylvian cistern). For all practical purposes, the case presented testifies to the necessity of intraoperative protection of the CSF spaces by separating any open CSF cisterns from the removed tumor mass with cotton pads. In case of diagnosing cerebral glioma, a possibility of the presence of multiple foci should be taken into account. It is especially important for the differentiation of multiple lesions occurring synchronically, where similarity of radiological features is seen in metastases, cerebral abscesses and demyelinating lesions.

The author discusses the current methods and tactics in surgery and intravascular treatment of cerebral aneurysms, based on the literature and own experience. In the light of the most important risk factors, the outcome of treatment of this vascular malformations was presented. In Poland, the surgical treatment remains the basic method, however intravascular treatment (coiling) become the valuable supporting treatment, and enlarges the possibilities of exclusion of the aneurysm from the cerebral circulation.

Background: Three available methods of therapy of arteriovenous malformations (AVM) i.e. microsurgical resection, intravascular embolization and stereotactic radiosurgery, make possible definitive treatment in the majority of patients. During qualification to these procedures the risk of complications and efficacy of each method should be considered., Objective: To analyze criteria of qualification, risk factors and results of embolization and surgical treatment of AVMs., Patients and Methods: Within four years (1999-2002) 53 patients were treated for arteriovenous malformations (AVMs) in the Department of Neurosurgery of the University Hospital in Krakow (24 women and 29 men). The group of 25 patients was treated with intravascular embolization, 20 patients were operated and 8 patients were treated conservatively or were qualified to radiotherapy. We retrospectively analyzed clinical findings, criteria of qualification and results of embolization as well as microsurgical treatment of AVMs with regard to Spetzler-Martin scale., Results: 25 patients qualified for embolization underwent 39 embolization procedures. Complete embolization of AVM was obtained in 4 (16%) cases. 18 patients (72%) presented very good or good condition on discharge. In 5 (20%) serious complications were noted: in 2 hemorrhagic and in 3 ischemic. Three patients (12%) died. In the group of 18 operated patients, 13 (72%) patients presented very good or good condition on discharge and 1 patient died because of hemorrhagic complications., Conclusions: 1. Spetzler-Martin scale is very useful in evaluation of operative risk of AVM operations but, in our opinion, before operation there should be considered also such factors like number and diameter of feeding arteries, exact localization of AVM and initial condition of the patient. 2. Although intravascular embolization is less invasive than neurosurgical operation, the risk of hemorrhagic and ischemic complications is present. 3. Complete AVM embolization is possible in the minority of patients. The remaining group require follow up and control radiological examinations to establish indications for further treatment.

Background: Microvascular decompression (MVD) is a method of choice in the surgical treatment of trigeminal neuralgia (TN)., Objective: To evaluate direct and long-term results of MVD in TN., Material and Methods: The authors analyzed 20 patients (9 women and 11 men, mean age 62.2 years) with TN who had been treated surgically at the Department of Neurosurgery of the University Hospital in Cracow between October 1998 and September 2002. MVD was performed using Janetta technique via suboccipital retro-sigmoid craniectomy. All patients underwent additional neurolysis. Indentations in portio major of the trigeminal nerve were present in 5 cases. Short- and long-term pain relief was assessed according to Slettebo-Eide scale., Results: Complete short-term pain relief was observed in 15 patients (75%), in 3 patients (15%) significant pain control was achieved. Very good and good long-term result was reported by 70% of patients. Pre-operative invasive treatment of neuralgia did not affect the long-term outcome. MVD of the trigeminal nerve indented by compression of the adjacent vessels yielded very good and good long-term result in 80% of patients compared with 66% in the group of patients with no trigeminal nerve indentation. In all of the 6 octogenarians very good or good pain control was observed. Duration of the history of trigeminal neuralgia did not influence the outcome. Severe postoperative complication (hemorrhagic cerebellar infarction) was observed in one case., Conclusion: Microvascular decompression is safe and effective method in the treatment of trigeminal neuralgia. MVD yields beneficial results in elderly patients.