Wewnątrznaczyniowe leczenie tętniaków naczyń mózgowych przy użyciu spirali odczepianych hydraulicznie

Background: Authors analysed results of endovascular treatment using platinum hydraulically detachable coils in ruptured and unruptured cerebral aneurysms. The aim of the study was to evaluate the efficacy of the presented method and safety of the treatment for patients with cerebral aneurysms. Material/Methods: Authors describe a clinical analysis in a group of 129 patients with 153 cerebral aneurysms treated with endovascular embolization in Department of Neurosurgery and Neurotraumatology of University of Medical Sciences in Poznań, Poland. 116 patients were hospitalized with a history of subarachnoidal hemorrhage, while 13 patients were without previous onset of bleeding. In bled group the clinical condition was assessed according to Hunt-Hess's scale. All patients were treated using Balt (MDS Pression) hydraulically detachable coils system. Based on angiographic examination results one evaluated the anatomical conditions of the aneurysm, its size, and relationship of the aneurysmal sac to its neck. Considering 116 patients with ruptured aneurysms, endovascular embolization within 72 hours was performed in 70 cases, in case of 46 patients the procedure was delayed. Results: Complete occlusion of the lumen of the aneurysmal sac was achieved in 126 (82.3%) patients, while incomplete occlusion in 27 (17.7%). The efficacy of embolization was connected with the size and morphology of the aneurysm, as well as the relationship of the neck to the aneurysmal sac. Complete embolization was obtained specially in case of small aneurysms and those with a narrow neck. Conclusions: Authors proof justness of transarterial embolisation as a highly effective first choice procedure of aneurismal sack exclusion from cerebral circulation

Spatial distribution of white matter degenerative lesions and cognitive dysfunction in relapsing-remitting multiple sclerosis patients

Aim. The aim of this study was to assess degenerative lesion localisation in the course of relapsing-remitting multiple sclerosis (RRMS) and to identify the association between localisation and the frequency of T1-hypointense lesions (black holes) with cognitive dysfunction. We also searched for neuroradiological predictors of cognitive dysfunction in patients. The clinical rationale for the study was previous research, and our own findings suggest that lesion localisation plays an important role in cognitive performance and neurological disability of MS patients. Material and methods. Forty-two patients were included in the study. All subjects underwent neuropsychological examination using Raven’s Coloured Progressive Matrices, a naming task from the Brief Repeatable Battery of Neuropsychological Tests, and attention to detail tests. Magnetic resonance imaging (MRI) was acquired on 1.5 Tesla scanner and black holes were manually segmented on T1-weighted volumetric images using the FMRIB Software Library. Linear regression was applied to establish a relationship between black hole volume per lobe and cognitive parameters. Bonferroni correction of voxelwise analysis was used to correct for multiple comparisons. Results. The following associations between black hole volume and cognition were identified: frontal lobes black hole volume was associated with phonemic verbal fluency (t = –4.013, p < 0.001), parietal black hole volume was associated with attention (t = –3.776, p < 0.001), and parietal and temporal black hole volumes were associated with nonverbal intelligence (p < 0.001). The volume of parietal black holes was the best predictor of cognitive dysfunction. Conclusions. Our approach, including measurement of focal axonal loss based on T1-volumetric MRI sequence and brief neuropsychological assessment, might improve personalised diagnostic and therapeutic decisions in clinical practice

Torbiele synowialne odcinka lędźwiowego kręgosłupa

Background and purpose Synovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal. Material and methods The retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis. Results Synovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients. Conclusions Surgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.Cel pracy Torbiele synowialne kręgosłupa występują najczęściej w odcinku lędźwiowo-krzyżowym. Opracowano zróżnicowane sposoby leczenia tych zmian zwyrodnieniowych, jednak w przypadkach przewlekłego bólu lub wystąpienia neurologicznych objawów ubytkowych zaleca się interwencję chirurgiczną. Celem pracy jest przedstawienie wskazań, techniki operacyjnej i skuteczności leczenia operacyjnego chorych z torbielą synowialną kanału kręgowego. Materiał i metody Retrospektywną analizą kliniczną objęto 11 pacjentów, w wieku od 47 do 72 lat, leczonych w Katedrze i Klinice Neurochirurgii i Neurotraumatologii UM w Poznaniu w latach 2004–2009. Długość wywiadu chorobowego wahała się od 2 miesięcy do 6 lat. Leczenie zachowawcze stosowane przed leczeniem operacyjnym nie dawało poprawy. W badaniu neurologicznym stwierdzono jednostronną lub obustronną rwę kulszową, zaburzenia czucia powierzchniowego bądź niedowłady kończyn dolnych. Wyniki Torbiel umiejscawiała się najczęściej na poziomie L4-L5 (9 przypadków). Badanie kręgosłupa za pomocą rezonansu magnetycznego (RM) zostało wykonane u wszystkich pacjentów i wykazało zmianę o charakterze torbielowatym, która była połączona ze stawem międzykręgowym. Leczenie operacyjne polegało w większości przypadków na jednostronnej fenestracji więzadła żółtego z wykorzystaniem techniki mikrochirurgicznej. Ustąpienie dolegliwości bólowych kręgosłupa zaobserwowano w 9 przypadkach. U 10 chorych ustąpiły objawy rwy kulszowej. Ubytkowe objawy neurologiczne wycofały się u 5 pacjentów. Wnioski Leczenie chirurgiczne torbieli synowialnych kręgosłupa jest metodą bezpieczną, efektywną i zapewniającą trwały efekt. Do leczenia operacyjnego kwalifikują się chorzy, u których objawy kliniczne korelują z obecnością torbieli w badaniach obrazowych i nie ustępują po leczeniu zachowawczym