Clipping versus coiling for intracranial aneurysms

Background and purpose The aim of this study was to compare results of clipping and coiling for aneurysms of the anterior circle of Willis. Previous studies have not identified a clear superiority of one method over the other. Material and methods The study group included 165 consecutive patients. The assessment took into account the risk of death, neurological status according to the scale of the GOS and mRS, the incidence of early complications and quality of life measured by own surveys and questionnaire EORTC QLQ-C30 v. 3.0. Results Mean follow-up was more than four years. Early and late results of treatment after embolization and clipping for all patients did not differ. Evaluation of patients with bleeding aneurysms demonstrated better outcomes after embolization, however statistical significance was observed only in terms of symptomatic scale score of QLQ-C30 questionnaire (p=0.02). For patients with non-bleeding aneurysms better outcomes were obtained after clipping, but statistical significance was found only in the early results: more excellent results in GOS score at discharge (p<0.03) and fewer complications during hospitalization (p=0.02). Conclusions Results of treatment after clipping and coiling do not differ in total for all patients, but differ depending on the presence of bleeding. Patients with bleeding aneurysms achieve better outcomes after coiling, and patients with non-bleeding aneurysms achieve better outcomes after clipping

Zastosowanie śródoperacyjnej tomografii komputerowej na neurochirurgicznej sali operacyjnej

Background and purpose The authors describe their own experience in use of intraoperative computed tomography (CT) with the Siemens SOMATOM Sensation in 125 cases. Material and methods Intraoperative CT of the head was most often used in functional neurosurgery for stereotactic planning in 32 cases and for control of deep brain stimulation electrode placement in 18 cases. In spine surgery, CT was used most often in spine stabilization to control the placement of implants. Results The implant had to be corrected in 7 cases (17% of 41 procedures), and in those cases the need for a revision procedure was therefore avoided. Intraoperative CT was also widely used in emergency procedures and perioperative complications in 13 cases, for control of intraventricular catheter or Rickham port placement in 8 cases, for evaluation of extent of tumour resection in 4 cases, for verification of electrode placement during percutaneous trigeminal rhizotomy in 3 cases, for evaluation of decompression after cervical corpectomy and thoracic discopathy in 3 cases, in complex fractures in 2 cases and as angio-CT after aneurysm clipping in 1 case. There was no significant prolongation of procedure duration. Intraoperative CT proved to be safe for a patient and for personnel. During the three-year evaluation period, the increasing use and indications for intraoperative CT were noted. Integration of CT with navigation is planned in the near future. Conclusions Intraoperative CT is a very useful tool in spine surgery as well as in functional neurosurgery and neurooncology.Wstęp i cel pracy Autorzy przedstawiają doświadczenia własne w zastosowaniu śródoperacyjnej tomografii komputerowej (TK) przy użyciu aparatu Siemens SOMATOM Sensation u 125 chorych. Materiał i metody W 10 Wojskowym Szpitalu Klinicznym w Bydgoszczy dwie sale neurochirurgiczne wyposażono w aparat TK umożliwiający wykonywanie badań śródoperacyjnych. Śródoperacyjną TK głowy wykonywano najczęściej w operacjach z zakresu neurochirurgii czynnościowej (do planowania zabiegu stereotaktycznego u 32 chorych i kontroli położenia elektrod po zabiegach głębokiej stymulacji mózgu u 18 chorych). W trakcie operacji kręgosłupa badanie przeprowadzano najczęściej podczas stabilizacji kręgosłupa, aby ocenić położenie implantów. Wyniki W 7 na 41 przypadków (17%) poprawiano położenie implantu – śródoperacyjna TK uchroniła tych chorych przed ponowną operacją. Śródoperacyjna TK znalazła również zastosowanie w stanach ostrych i pogorszeniu stanu chorego po zabiegu (13), w ocenie położenia drenu zastawki, drenażu, zbiornika Rickhama (8), w ocenie doszczętności usunięcia guza (4), w ocenie położenia elektrody do elektrokoagulacji zwoju Gassera (3), w ocenie odbarczenia po korpektomii szyjnej i operacji krążka międzykręgowego w odcinku piersiowym (3), w skomplikowanych złamaniach (2) oraz jako angio-TK po klipsowaniu tętniaka (1). Metoda ta nie przedłuża istotnie czasu trwania operacji. Jest bezpieczna dla chorego i dla personelu. Z blisko trzyletniej obserwacji wynika, że częstość wykonywania śródoperacyjnej TK rośnie, a wskazania do jej stosowania rozszerzają się. Planuje się zastosowanie TK na bloku operacyjnym jako jednego z elementów zintegrowanego systemu nawigacji w związku z jej modernizacją. Wnioski Śródoperacyjna TK jest bardzo przydatnym urządzeniem zarówno w chirurgii kręgosłupa, jak i w operacjach z zakresu neurochirurgii czynnościowej i neuroonkologii

Wyniki neuromodulacyjnego leczenia bólu przewlekłego

Background and purpose Neuromodulative treatment of chronic pain syndromes is a modern mode of treatment of neuropathic and ischaemic pain. Its effectiveness is well documented in the literature. The objective of this work is to present the results of treatment of chronic pain syndromes on the basis of eight-year experience in our department. Material and methods Since 2002, we have conducted 9 operations of motor cortex stimulation (MCS), 2 of deep brain stimulation (DBS), 45 of spinal cord stimulation (SCS) and 5 of sacral root stimulation (SRS) in the treatment of chronic pain. Results We obtained good long-term results of neuromodulation in the form of clinical improvement (> 50%) in 4 of 9 patients with MCS (44%), in 13 diagnosed with failed back surgery syndrome (FBSS), 8 with other neuropathic pain, and 11 with angina pectoris from a group of 45 treated with SCS. Sacral root stimulation has been successful in 3 of 5 patients with perianal pain. The best treatment results in SCS, although not statistically significant, were observed in patients treated due to FBSS (13 out of 15) and angina pectoris (11 out of 15) (p = 0.12). In patients with neuropathic pain, peripheral and central, improvement was obtained in 8 out of 15 patients. Conclusions A good indication for spinal cord stimulation is FBSS and angina pectoris. Motor cortex stimulation is helpful in the treatment of chronic central neuropathic pain. Further observations and a larger group of patients are necessary for a reliable assessment of the effectiveness of neuromodulative treatment of chronic pain in our clinic.Wstęp i cel pracy Neuromodulacyjne leczenie bólu przewlekłego to nowoczesna forma leczenia bólu neuropatycznego i niedokrwiennego. Jego efektywność została dobrze udokumentowana w piśmiennictwie. Celem pracy jest przedstawienie wyników leczenia przewlekłych zespołów bólowych na podstawie ośmioletniego doświadczenia kliniki autorów. Materiał i metody Od 2002 r. w leczeniu bólu przewlekłego przeprowadzono 9 zabiegów stymulacji kory mózgu (MCS), 2 głębokiej stymulacji mózgu (DBS), 45 stymulacji rdzenia kręgowego (SCS) i 5 stymulacji korzeni krzyżowych (SRS). Wyniki Otrzymano dobre odległe wyniki neuromodulacji w postaci poprawy klinicznej (co najmniej o 50%) u 4 spośród 9 pacjentów z MCS (44%), u 13 z rozpoznaniem dyskopatii lędźwiowej (FBSS) oraz u 8 z innym bólem neuropatycznym, a także u 11 z dusznicą bolesną z grupy 45 poddanych SCS. Stymulacja korzeni krzyżowych była skuteczna u 3 spośród 5 pacjentek z bólem okolicy okołoodbytniczej. Najlepsze wyniki leczenia, choć nieznamienne statystycznie, zaobserwowano w SCS u pacjentów leczonych z powodu zespołu bólowego kręgosłupa o typie FBSS (13 spośród 15 pacjentów) oraz dławicy piersiowej (11 spośród 15) (p = 0,12). W grupie pacjentów z bólem neuropatycznym obwodowym i ośrodkowym poprawę uzyskano u 8 spośród 15 osób. Wnioski Dobrymi wskazaniami do stymulacji rdzenia kręgowego są przewlekły zespół bólowy o typie FBSS i dusznica bolesna. Stymulację kory mózgu można z powodzeniem stosować w leczeniu ośrodkowego bólu neuropatycznego. Do przeprowadzenia wiarygodnej oceny skuteczności leczenia neuromodulacyjnego bólu przewlekłego w klinice autorów niezbędne są dalsze obserwacje i większa grupa pacjentów poddanych różnym procedurom

Wyniki monitorowania neurofizjologicznego operacji kanału kręgowego

Background and purpose Spine surgery carries the risk of neurological complications. Neurophysiological intraoperative monitoring (NIOM) plays some role in preventing adverse events. NIOM is a young technique, and because of its costs and additional personnel it requires constant evaluation of indications. Nowadays, it is generally assumed that if available, NIOM should be used in every intracanal surgical procedure. This study aimed to evaluate the efficacy and indications for NIOM in spine surgery in relation to procedure location. Material and methods Effectiveness of NIOM in spinal canal surgery was evaluated by comparison of the number of neurological complications in patients treated surgically with and without NIOM. A total of 74 consecutive patients were surgically treated for spinal canal pathology at the Department of Neurosurgery, 10th Military Hospital in Bydgoszcz. Thirty-eight patients operated on with the use of NIOM were compared to a historic population of 36 patients treated before the introduction of NIOM. The number of patients with neurological complications was analyzed in three groups based on surgical location: extradural, intradural extramedullary, and intramedullary procedures. Differences between groups were tested with the Fisher exact test. Results The number of neurological complications was significantly lower in the intramedullary procedure group with NIOM. There was no significant difference in the number of complications in patients undergoing intra- or extradural extramedullary procedures with versus without NIOM. Conclusions NIOM decreases the risk of neurological complications in spinal cord surgery, but not in extramedullary spinal canal procedures.Wstęp i cel pracy Operacje kanału kręgowego są obarczone wyjątkowo dużym ryzykiem powikłań neurologicznych. Jedna z najważniejszych metod zmniejszania ryzyka powikłań operacji to śródoperacyjne monitorowanie neurofizjologiczne (neurophysiologic intraoperative monitoring – NIOM). Jest to technika młoda i ze względu na koszty aparatury oraz dodatkowego personelu konieczna jest ocena jej skuteczności i ustalenie wskazań do jej stosowania. Obecnie zakłada się, że jeżeli technika NIOM jest dostępna, to powinna być zastosowana w każdego rodzaju operacjach kanału kręgowego. Celem pracy była ocena skuteczności i zasadności NIOM w operacjach kanału kręgowego w odniesieniu do zakresu procedury. Materiał i metody Skuteczność NIOM w operacjach kanału kręgowego oceniono poprzez porównanie liczby powikłań neurologicznych po zabiegach z użyciem NIOM i bez zastosowania NIOM. Badaniem objęto 74 kolejnych chorych operowanych w zakresie kanału kręgowego w Klinice Neurochirurgii 10. Wojskowego Szpitala w Bydgoszczy. Wyniki leczenia 38 chorych operowanych z wykorzystaniem NIOM porównano z wynikami w historycznej grupie kontrolnej, którą stanowiło 36 kolejnych chorych operowanych przed wprowadzeniem tej techniki. Oceniono liczbę powikłań neurologicznych po operacjach w trzech grupach – zewnątrz-oponowych, wewnątrzoponowych, zewnątrzrdzeniowych oraz wewnątrzrdzeniowych. Istotność różnic oceniano przy zastosowaniu testu dokładnego Fishera. Wyniki Po operacjach rdzenia kręgowego stwierdzono istotnie mniejszą liczbę powikłań w grupie chorych operowanych z wykorzystaniem NIOM. Nie stwierdzono istotnej różnicy pomiędzy wynikami operacji prowadzonych zewnątrzrdze-niowo – wewnątrzoponowo ani zewnątrzoponowo. Wnioski Śródoperacyjne monitorowanie neurofizjologiczne podczas operacji rdzenia kręgowego zmniejszyło liczbę powikłań neurologicznych, ale w przypadku operacji zewnątrz-rdzeniowych nie wpłynęło istotnie na neurologiczny wynik leczenia

A new strategy for brain tumour metabolomic analysis

Introduction: Nowadays, diagnosis of brain tumours is mainly carried out via neuroimaging techniques. The most widespread methods for routine analysis include computer tomography and magnetic resonance imaging. While such methods are useful to localise tumours, they are unable to offer a conclusive diagnosis of the tumour type. A final diagnosis can only be made via a histological examination of tissue after tumour resection, or, in cases where the location of the tumour is not amenable to resection, after a biopsy of the tumour is carried out. Untargeted metabolite analysis is a relatively new approach to diagnostics, capable of establishing wide characterisation of endogenous metabolites of a given system, a method that can be applied to improve identification of tumour types via biomarker discovery. In this regard, sample collection and preparation can be said to be the most important step in metabolomic studies. Material and methods: In the current study, a solid phase microextraction (SPME) protocol for metabolo-mics, which has been successfully applied towards metabolite analysis in various biological materials in the last few years, was optimised for brain tumour tissue metabolomic analysis. In the current study, the described approach was applied to human brain tumours. Aiming to incur minimal tissue damage, the probes used for sampling were of diameter ca. 0.2 mm. Aiming to optimise the method towards enhanced recovery of the extracted metabolites, various desorption solvents were tested in an optimisation study. The final protocol was used for analysis of a pilot cohort of patients with glioma and meningioma tumours. Results: The results showed that a protocol where chemical biopsy was performed directly from resected tumour with 7-mm-long coating SPME probe and desorption was done using 0.3 mL of a mixture of acetonitrile and water 80:20 v/v was superior to other tested protocols. The optimised method allowed for successful differentiation between the two types of brain tumours studied: meningioma and glioma. Despite the relatively small cohort group involved in the study, several compounds were tentatively identified as statistically significant metabolites responsible for this differentiation. Conclusions: The presented preliminary data demonstrate a potential of the proposed method as a low invasive diagnostic tool for on-site analysis

Krzysztof Czermański, Więzienie w Sztumie w epoce totalitaryzmów 1933–1956, wyd. Bernardinum, Pelplin 2014, ss. 359 + il.

Omówienie publikacji: Krzysztof Czermański, Więzienie w Sztumie w epoce totalitaryzmów 1933–1956, wyd. Bernardinum, Pelplin 2014, ss. 359 + il

Sub-Perception and Supra-Perception Spinal Cord Stimulation in Chronic Pain Syndrome: A Randomized, Semi-Double-Blind, Crossover, Placebo-Controlled Trial

Background: The introduction of modern sub-perception modalities has improved the efficacy of spinal cord stimulation (SCS) in refractory pain syndromes of the trunk and lower limbs. The objective of this study was to evaluate the effectiveness of low and high frequency SCS among patients with chronic pain. Material and methods: A randomised, semi-double-blind, placebo controlled, four period (4 × 2 weeks) crossover trial was conducted from August 2018 to January 2020. Eighteen patients with SCS due to failed back surgery syndrome and/or complex regional pain syndrome were randomised to four treatment arms without washout periods: (1) low frequency (40-60 Hz), (2) 1 kHz, (3) clustered tonic, and (4) sham SCS (i.e., placebo). The primary outcome was pain scores measured by visual analogue scale (VAS) preoperatively and during subsequent treatment arms. Results: Pain scores (VAS) reported during the preoperative period was M (SD) = 8.13 (0.99). There was a 50% reduction in pain reported in the low frequency tonic treatment group (M (SD) = 4.18 (1.76)), a 37% reduction in the 1 kHz treatment group (M (SD) = 5.17 (1.4)), a 34% reduction in the clustered tonic settings group (M (SD) = 5.27 (1.33)), and a 34% reduction in the sham stimulation group (M (SD) = 5.42 (1.22)). The reduction in pain from the preoperative period to the treatment period was significant in each treatment group (p < 0.001). Overall, these reductions were of comparable magnitude between treatments. However, the modality most preferred by patients was low frequency (55% or 10 patients). Conclusions: The pain-relieving effects of SCS reached significance and were comparable across all modes of stimulation including sham. Sub-perception stimulation was not superior to supra-perception. SCS was characterised by a high degree of placebo effect. No evidence of carryover effect was observed between subsequent treatments. Contemporary neuromodulation procedures should be tailored to the individual preferences of patients

Metabolomic Phenotyping of Gliomas: What Can We Get with Simplified Protocol for Intact Tissue Analysis?

Glioblastoma multiforme is one of the most malignant neoplasms among humans in their third and fourth decades of life, which is evidenced by short patient survival times and rapid tumor-cell proliferation after radiation and chemotherapy. At present, the diagnosis of gliomas and decisions related to therapeutic strategies are based on genetic testing and histological analysis of the tumor, with molecular biomarkers still being sought to complement the diagnostic panel. This work aims to enable the metabolomic characterization of cancer tissue and the discovery of potential biomarkers via high-resolution mass spectrometry coupled to liquid chromatography and a solvent-free sampling protocol that uses a microprobe to extract metabolites directly from intact tumors. The metabolomic analyses were performed independently from genetic and histological testing and at a later time. Despite the small cohort analyzed in this study, the results indicated that the proposed method is able to identify metabolites associated with different malignancy grades of glioma, as well as IDH and 1p19q codeletion mutations. A comparison of the constellation of identified metabolites and the results of standard tests indicated the validity of using the characterization of one comprehensive tumor phenotype as a reflection of all diagnostically meaningful information. Due to its simplicity, the proposed analytical approach was verified as being compatible with a surgical environment and applicable for large-scale studies

Investigating the Potential Use of Chemical Biopsy Devices to Characterize Brain Tumor Lipidomes

The development of a fast and accurate intraoperative method that enables the differentiation and stratification of cancerous lesions is still a challenging problem in laboratory medicine. Therefore, it is important to find and optimize a simple and effective analytical method of enabling the selection of distinctive metabolites. This study aims to assess the usefulness of solid-phase microextraction (SPME) probes as a sampling method for the lipidomic analysis of brain tumors. To this end, SPME was applied to sample brain tumors immediately after excision, followed by lipidomic analysis via liquid chromatography-high resolution mass spectrometry (LC-HRMS). The results showed that long fibers were a good option for extracting analytes from an entire lesion to obtain an average lipidomic profile. Moreover, significant differences between tumors of different histological origin were observed. In-depth investigation of the glioma samples revealed that malignancy grade and isocitrate dehydrogenase (IDH) mutation status impact the lipidomic composition of the tumor, whereas 1p/19q co-deletion did not appear to alter the lipid profile. This first on-site lipidomic analysis of intact tumors proved that chemical biopsy with SPME is a promising tool for the simple and fast extraction of lipid markers in neurooncology

Investigating the Potential Use of Chemical Biopsy Devices to Characterize Brain Tumor Lipidomes

The development of a fast and accurate intraoperative method that enables the differentiation and stratification of cancerous lesions is still a challenging problem in laboratory medicine. Therefore, it is important to find and optimize a simple and effective analytical method of enabling the selection of distinctive metabolites. This study aims to assess the usefulness of solid-phase microextraction (SPME) probes as a sampling method for the lipidomic analysis of brain tumors. To this end, SPME was applied to sample brain tumors immediately after excision, followed by lipidomic analysis via liquid chromatography-high resolution mass spectrometry (LC-HRMS). The results showed that long fibers were a good option for extracting analytes from an entire lesion to obtain an average lipidomic profile. Moreover, significant differences between tumors of different histological origin were observed. In-depth investigation of the glioma samples revealed that malignancy grade and isocitrate dehydrogenase (IDH) mutation status impact the lipidomic composition of the tumor, whereas 1p/19q co-deletion did not appear to alter the lipid profile. This first on-site lipidomic analysis of intact tumors proved that chemical biopsy with SPME is a promising tool for the simple and fast extraction of lipid markers in neurooncology