Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom tijekom karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnog premošćivanja

Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endarterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom za vrijeme karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnih premoštenja veoma je značajno, jer omogućava promatranje protoka u srednjoj moždanoj arteriji u stvarnom vremenu. Dostatan protok krvi u srednjoj moždanoj arteriji za vrijeme karotidne endarterektomije omogućava selektivan izbor intraluminalog spoja (shunt) i operaciju bez njega, pravodobno otkrivanje moždane hiperperfuzije, vazospazma, hipoperfuzije i cerebralnih mikroembolija, što može bitno smanjiti poslijeoperacijske neurološke komplikacije kao cerebrovaskularni incident ili kognitivnu disfunkciju

Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom tijekom karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnog premošćivanja

Intraoperative transcranial Doppler monitoring of intracranial blood flow during carotid endarterectomy, surgical management of intracranial aneurysms and coronary artery bypass grafting is important because it enables recording of the flow in the middle cerebral artery in real time. An adequate blood flow through the middle cerebral artery during carotid endarterectomy allows for selective choice of intraluminal shunt as well as an operation without it, timely identification of cerebral hyperperfusion, vasospasm and hypoperfusion, and detection of cerebral microembolisms, thus minimizing postoperative neurologic complications such as cerebrovascular events or cognitive dysfunction.Intraoperacijsko praćenje moždanog krvnog protoka transkranijskim Dopplerom za vrijeme karotidne endarterektomije, kirurškog liječenja moždanih aneurizma i koronarnih premoštenja veoma je značajno, jer omogućava promatranje protoka u srednjoj moždanoj arteriji u stvarnom vremenu. Dostatan protok krvi u srednjoj moždanoj arteriji za vrijeme karotidne endarterektomije omogućava selektivan izbor intraluminalog spoja (shunt) i operaciju bez njega, pravodobno otkrivanje moždane hiperperfuzije, vazospazma, hipoperfuzije i cerebralnih mikroembolija, što može bitno smanjiti poslijeoperacijske neurološke komplikacije kao cerebrovaskularni incident ili kognitivnu disfunkciju

Hypophyseal metastases: A report of three cases and literature review

Metastatic tumours to the pituitary gland are rare. The most frequent are metastases from breast and lung. We describe three patients with metastatic tumours: (I) a 54-year-old patient with metastatic renal clear-cell carcinoma and consequent disturbances in visual acuity, cranial nerve paresis and panhypopituitarism, (II) a 60-year-old patient with a diffuse large B-cell lymphoma with panhypopituitarism and diabetes insipidus and (III) a 57-year-old patient with metastasis of breast cancer and panhypopituitarism, visual impairment and cranial nerve paresis. A transnasal endoscopic biopsy and resection of the tumour was performed in all patients, followed by the oncological treatment. Despite the rarity of the disease, it is important to suspect a metastatic pituitary tumour especially in the case of diabetes insipidus, ophthalmoplegia, rapid course of the disease and headaches. In 20–30% of patients, a metastasis to the pituitary is the first manifestation of a tumour of unknown origin. Surgical and adjuvant therapy may improve the quality of life. The survival is not affected, however, and the prognosis of the disease is usually poor

Biomaterials and host versus graft response

Biomaterials and biotechnology are increasing becoming an important area in modern medicine. The main aim in this area is the development of materials, which are biocompatible to normal tissue. Tissue-implant interactions with molecular, biological and cellular characteristics at the implant-tissue interface are important for the use and development of implants. Implantation may cause an inflammatory and immune response in tissue, foreign body reaction, systemic toxicity and imminent infection. Tissue-implant interactions determine the implant life-period. The aims of the study are to consider the biological response to implants. Biomaterials and host reactions to implants and their mechanisms are also briefly discussed

Attenuation of cerebral vasospasm in rabbits using clonidine hydrochloride, a central adrenergic agonist

The aim of this study was to assess, firstly, if exclusion of central noradrenergic areas in the hypothalamus and brain stem with the central sympathetic blocker clonidine hydrochloride could prevent the development of chronic vasospasm following experimental subarachnoid haemorrhage in rabbits and, secondly, if, parallel with the effect on cerebral arteries, changes in dopamine -hydroxylase concentration in the hypothalamus and brain stem could also be detected. Experimental subarachnoid haemorrhage, in concentrations of 1 ml of autologous arterial bloodž1 kg of body weight was carried out on 18 New Zealand rabbits. Histological specimens were obtained by the method of perfusion fixation after the rabbits were sacrificed on day 8 after subarachnoid haemorrhage. The spastic effect of experimentally induced subarachnoid haemorrhage was determined by assessing the intensity of corrugation of the intima of the rabbit basilar artery by the previously developed method of corrugation coefficient and computer image analysis. The concentration and localization of dopamine -hydroxylase in noradrenaline-containing neurons was immunohistochemically assessed (semiquantitatively as 0, 1 and 2) with anti-dopamine -hydroxylase, at precisely defined sites of the hypothalamus and brain stem of the same rabbit. The results revealed less corrugated and smoother intima in the basilar artery and significantly lower dopamine -hydroxylase concentration in the control group of rabbits with sham subarachnoid haemorrhage and without any additional interventions (mean corrugation COEFFICIENT=1.123 0.024, P=0.3510-3č mean dopamine -hydroxylase=0.350 0.071, P=0.22 10-3), and smootherintima in the basilar artery with significantly lower concentration ofdopamine -hydroxylase in the clonidine group (rabbits with subarachnoid haemorrhage and central 2-blocker clonidine hydrochloride at a daily dose of 0.03 mgžkg of body weight for 8 daysč mean corrugation COEFFICIENT=1.177 0.058, P=1.7 10-3č mean dopamine -hydroxylase=0.583 0.175, P=1.1 10-3). In comparison, the haemorrhage only group (rabbits with subarachnoid haemorrhage and without medicationč mean corrugation COEFFICIENT=1.370 0.101č mean dopamine -hydroxylase=1.214 0.313) displayed intensive corrugation of the intima of the basilar artery and a significantly more intensive accumulation of dopamine -hydroxylase than did the control group and the clonidine group. The results of this study demonstrated that the central 2-blocker clonidine hydrochloride effectively prevents vasospasm, and diminishes the concentration of cerebral dopamine -hydroxylase in the hypothalamus and brain stem after experimental subarachnoid haemorrhage in rabbits

Pelvic expansion hidden by concomitant lumbar compression as a cause of sciatica - report of three cases

Ekspanzivni procesi v mali medenici, prikriti s sočasno lumbalno kompresijo, kot vzrok lumboishialgij

Colloid cysts of the third ventricle exhibit various clinical presentation: a review of three cases

Colloid cysts are benign intracranial tumours usually occurring in the front part of the third ventricle. Clinical presentation may be non-specific and heterogeneous. The problems are frequently associated with development of hydrocephalus, these cysts may cause. We describe three cases of patients with diverse clinical symptoms, who underwent surgery for colloid cysts of the third ventricle. In the first patient, the colloid cyst caused a sudden deterioration of consciousness due to an acute hydrocephalus. The cyst in the second and third patient was discovered accidentally, during the course of epileptic seizures treatment and due to chronic headache with quanti- and qualitative deterioration of consciousness in the setting of chronic hydrocefalus, respectively. Surgery improved health in all three patients

Use of neuronavigational system at the Department of neurosurgery in the General hospital Maribor

Izhodišča. Nevronavigacijski sistem je računalniško podprt sistem za medoperativno načrtovanje in vodenje nevrokirurških postopkov z interaktivnim slikovnim prikazom. Številni nevronavigacijski sistemi uporabljajo različne tehnične rešitve za medoperativno spremljanje. Uporabo takega sistema imenujemo nevronavigacija. Metode. Od junija 2002 do aprila 2003 smo na Oddelku za nevrokirurgijo Splošne bolnišnice Maribor z nevronavigacijo operirali 14 bolnikov (povprečna starost 52 let). Uporabljali smo nevronavigacijski sistem, ki temelji na zaznavanju infrardečih odbojev in medoperativnem spremljanju s pomočjo računalniškotomografskega slikovnega prikaza v treh ravninah. Rezultati. Nevronavigacijski sistem smo uporabili v štirih primerih biopsije, štirih primerih redukcije spremembe ter v šestih primerih popolne odstranitve spremembe. 11 možganskih sprememb je ležalo subkortikalno ali globje, dve sta bili kortikalni možganski spremembi, ena pa osteolitična sprememba v možganski kosti. Povprečni premer je znašal 3,5 cm. Izračunana natančnost interaktivnega slikovnega prikaza je bila dobra pri vseh 14 bolnikih. Zaključki. Nevronavigacijski sistem, ki ga uporabljamo, je enostaven in dokaj natančen. Poveča hitrost, varnost in zanesljivost pri večini posegov na možganih.Background. Neuronavigational system is a computerised system for intraoperative planning and guidance of neurosurgical procedures using interactive image presentation. The application of such system is denoted as neuronavigation. There are many neuronavigational systems with different technical solutions for intraoperative guidance. Methods. From June 2002 till April 2003 fourteen patients (mean age 52 years) were operated using of neuronavigational system on department of neurosurgery in Maribor General Hospital. We used neuronavigational system based on infrared light detection and intraoperative guidance with the help CT imaging in three-planes. Results. The system was used in four cases of biopsy, four cases of lesion reduction and six cases of total lesion removal. 11 brain lesion were situated subcorticaly or deeper, two were cortical and one was osteolitic lesion of the skull bone. Lesions mean diameter was 3.5 cm. Calculated accuracy of interactive image-guidance was good in all 14 cases. Conclusions. Neuronavigational system which we used is simple and quite accurate. Its usage improves speed, safety and accuracy of most neurosurgical procedures