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This study evaluated the frequency and risk factors for surgery dissatisfaction in patients undergoing lumbar or cervical surgery for degenerative spinal conditions. Based on the Patient Satisfaction Index (PSI) at 6 months after surgery, we divided patients into two groups: a satisfied and a dissatisfied group. We evaluated the association between patient dissatisfaction and five categories of variables:1) sociodemographic; 2) preoperative pain and disability [pain duration, level of surgery, previous spinal surgeries, pain scores as measured by the Short Form McGill Pain Questionnaire (SF-MPQ), numerical rating of average pain (NRS), disability as measured by the Oswestry Disability Index (ODI)]; 3) preoperative psychological status [depression, anxiety, and overall distress as measured by the Hospital Anxiety and Depression Scale (HADS), life satisfaction as measured by the Satisfaction With Life Scale (SWLS), and surgery expectations (SE) as measured by a Likert scale]; 4) postoperative improvements in pain and disability [improvements in SF-MPQ, improvement in ODI] and 5) postoperative psychological status [HADS, SWLS]. Results showed that 17.8% patients were dissatisfied with surgery. In the multivariate logistic analysis, more negative surgery expectations, smaller improvement in ODI scores, and a greater postoperative overall distress were significant risk factors associated with patient dissatisfaction with surgery.

Influence of an intracranial aneurysm (IA) rupture on the expression of miRNAs and the potential significance of the resulting changes remains poorly understood. We aimed to characterize the response to the IA rupture through the analysis of miRNAs in peripheral blood cells. Expression of small RNAs was investigated using deep transcriptome sequencing in patients in the acute phase of an IA rupture (first 72 h), in the chronic phase (3–15 months), and controls. A functional analysis and the potential interactions between miRNAs and target genes were investigated. We also measured the levels of proteins that were influenced by regulated miRNAs. We found that 106 mature miRNAs and 90 miRNA precursors were differentially expressed among the groups. The regulated miRNAs were involved in a variety of pathways, and the top pathway involved cytokine-cytokine receptor interactions. The identified miRNAs targeted the inflammatory factors HMGB1 and FASLG. Changes in their expression were detected at the mRNA and protein levels. IA rupture strongly influences the transcription profiles in peripheral blood cells. The regulated miRNAs were involved in the control of immune cell homeostasis. In summary, these results may aid in the elucidation of the molecular mechanisms that orchestrate the inflammatory response to IA rupture. Electronic supplementary material The online version of this article (10.1007/s12035-019-01789-1) contains supplementary material, which is available to authorized users.

Three right-handed patients diagnosed with Holmes tremor (HT), who suffered from pharmacotherapy-refractory tremor, were eligible for unilateral posterior subthalamic area deep brain stimulation (PSA-DBS). All patients were evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) and Clinical Global Impression scale (CGI) before DBS, 6, and 12 months after the PSA-DBS as well as at the last follow-up. In all patients, we observed a significant improvement of tremor control as demonstrated by changes in the FTMTRS and the CGI scales. Mean improvement of tremor in all patients was 56% for the FTMRTS with a corresponding change in the CGI scale. Our study demonstrates that PSA-DBS is efficacious in the treatment of HT. Indeed, PSA is a promising target for DBS for intractable proximal and distal tremor, even in cases of previous, suboptimal functional neurosurgery. The beneficial effect lasts over a long-term follow-up. PSA-DBS may be considered as an alternative target of DBS in tremor treatment.

BACKGROUND Very large cranial defects are not very common in neurosurgical practice and there is not any widely acknowledged standard of their treatment. One of the useful methods in such cases is individual forming of polypropylene-polyester knitwear. Such material was used in the past but before 2008 it was available only as standardized plates. Currently, it can be also produced as individually-shaped implants. The authors give their definition of very large cranial defects and present their experience with this cranioplastic method in such defects. METHODS The authors collected data on 11 cases of patients with very large cranial defects, from a total of 156 cases, operated on in 5 Polish neurosurgical departments. The necessary implants were prepared for individual patients according to the data provided by a computed tomography examination and with the use of computer aided machining. RESULTS All defects were larger than 120 cm2 (129 to 178 cm2) and exceeded 1/4 of the calvaria area. Patients were operated between 2008 to 2012. In all patients, a very good aesthetic result and correct skull reconstruction was achieved. The follow-up time in all cases exceeded 1 year and reached 4 years in one case. No complications were observed. CONCLUSIONS Individually pre-shaped polypropylene-polyester knitwear prostheses are a good alternative to the existing cranioplasty methods, particularly in very large cranial defects.

BACKGROUND The purpose of our research was to evaluate the relationships between blood viscosity and recanalization of coiled intracranial aneurysms. MATERIAL AND METHODS The study included consecutives patients treated endovascularly by a team of experienced neurosurgeons and neuroradiologists due to brain aneurysm. A total of 50 patients (the average age was 57.48 years, SD=13.71) were assigned to 2 groups: group A with recanalization (4 male and 8 female patients) and group B without recanalization (10 male and 28 female patients) were examined. All patients underwent a 6-month follow-up of the whole-blood viscosity test with a Brookfield DV III+pro cone-plate viscometer using the Rheocalc program. Differences between groups were assessed using the Statistica 12 computer program (StatSoft Inc., Tulsa, OK, USA). RESULTS Studies have shown no significant difference in the age range between group A and B (P=0.31). In group A, higher viscosity values were found for whole blood [median: 4.14 dyn×sec/cm² (mPa×sec) quartile range 0.42], compared to group B [median: 3.92 dyn×sec/cm² (mPa×sec); quartile range 0.40; (P=0.04)]. This difference was significant (P=0.04). Additionally, the level of hematocrit was positively related with recanalization, the higher the hematocrit, the more frequent recanalization. A very strong and statistically significant relationship occurred between the frequency of recanalization and smoking (P

Multiple classes of small RNAs (sRNAs) are expressed in the blood and are involved in the regulation of pivotal cellular processes. We aimed to elucidate the expression patterns and functional roles of sRNAs in the systemic response to intracranial aneurysm (IA) rupture. We used next-generation sequencing to analyze the expression of sRNAs in patients in the acute phase of IA rupture (first 72 h), in the chronic phase (3–15 months), and controls. The patterns of alterations in sRNA expression were analyzed in the context of clinically relevant information regarding the biological consequences of IA rupture. We identified 542 differentially expressed sRNAs (108 piRNAs, 99 rRNAs, 90 miRNAs, 43 scRNAs, 36 tRNAs, and 32 snoRNAs) among the studied groups with notable differences in upregulated and downregulated sRNAs between the groups and sRNAs categories. piRNAs and rRNAs showed a substantial decrease in RNA abundance that was sustained after IA rupture, whereas miRNAs were largely upregulated. Downregulated sRNA genes included piR-31080, piR-57947, 5S rRNA, LSU-rRNA, and SSU-rRNA s. Remarkable enrichment in the representation of transcription factor binding sites was revealed in genomic locations of the regulated sRNA. We found strong overrepresentation of glucocorticoid receptor, retinoid x receptor alpha, and estrogen receptor alpha binding sites at the locations of downregulated piRNAs, tRNAs, and rRNAs. This report, although preliminary and largely proof-of-concept, is the first to describe alterations in sRNAs abundance levels in response to IA rupture in humans. The obtained results indicate novel mechanisms that may constitute another level of control of the inflammatory response.Key messagesA total of 542 sRNAs were differentially expressed after aneurysmal SAH comparing with controlspiRNAs and rRNAs were upregulated and miRNAs were downregulated after IA ruptureThe regulated sRNA showed an enrichment in the representation of some transcription factor binding sitespiRNAs, tRNAs, and rRNAs showed an overrepresentation for GR, RXRA, and ERALPHA binding sites

The present paper is a review of studies on the role of the cerebellum in the regulation of language functions. This brain structure until recently associated chiefly with motor skills, visual-motor coordination and balance, proves to be significant also for cognitive functioning. With regard to language functions, studies show that the cerebellum determines verbal fluency (both semantic and formal) expressive and receptive grammar processing, the ability to identify and correct language mistakes, and writing skills. Cerebellar damage is a possible cause of aphasia or the cerebellar mutism syndrome (CMS). Decreased cerebellocortical connectivity as well as anomalies in the structure of the cerebellum are emphasized in numerous developmental dyslexia theories. The cerebellum is characterized by linguistic lateralization. From the neuroanatomical perspective, its right hemisphere and dentate nucleus, having multiple cerebellocortical connections with the cerebral cortical language areas, are particularly important for language functions. Usually, language deficits developed as a result of a cerebellar damage have subclinical intensity and require applying sensitive neuropsychological diagnostic tools designed to assess higher verbal functions.

Background Rupture of an intracranial aneurysm (IA) causes a systemic response that involves an immune/inflammatory reaction. Our previous study revealed a downregulation of genes related to T lymphocytes and an upregulation of genes related to monocytes and neutrophils after IA rupture. It remains unknown whether that resulted from alterations in transcription or cell count. We sought to characterize the systemic response to IA rupture through analysis of transcript expression profiles in peripheral blood cells. We also investigated effects of IA rupture on the composition of mononuclear cells in peripheral blood. Methods We included 19 patients in the acute phase of IA rupture (RAA, first 72 h), 20 patients in the chronic phase (RAC, 3–15 months), and 20 controls. Using deep transcriptome sequencing, we analyzed the expression of protein-coding and noncoding RNAs. Expression levels, transcript biotypes, alternative splicing and other features of the regulated transcripts were studied. A functional analysis was performed to determine overrepresented ontological groups among gene expression profiles. Flow cytometry was used to analyze alterations in the level of mononuclear leukocyte subpopulations. Results Comparing RAA and controls, we identified 491 differentially expressed transcripts (303 were downregulated, and 188 were upregulated in RAA). The results indicate that the molecular changes in response to IA rupture occur at the level of individual transcripts. Functional analysis revealed that the most impacted biological processes are related to regulation of lymphocyte activation and toll-like receptor signaling pathway. Differences between RAC and controls were less prominent. Analysis of leukocyte subsets revealed a significantly decreased number of CD4+ lymphocytes and increase of classical and intermediate monocytes in RAA patients compared to controls. Conclusions IA rupture in the acute phase strongly influences the transcription profiles of peripheral blood cells as well as the composition of mononuclear cells. A specific pattern of gene expression alteration was found, suggesting a depression of lymphocyte response and enhancement of monocyte activity. Electronic supplementary material The online version of this article (10.1186/s12967-019-1891-6) contains supplementary material, which is available to authorized users.

Introduction Selection of the optimal treatment method of intra- and paraventricular tumors often requires histopathological verification that can be obtained by endoscopic biopsy. Aim To discuss the usefulness of the method in their own experience. Material and methods The results of 32 biopsies carried out during a 15-year period were reviewed retrospectively. All tumors were located supratentorially, 25 of them were intraventricular and 7 paraventricular. In 18 patients the tumor was accompanied by internal hydrocephalus. If the ventricular system was narrow, the biopsy was supported by a neuronavigation system. A rigid neuroendoscope was used. The obtained material was subjected to intraoperative and final histopathological examination. Results Viable diagnostic material was obtained from all patients. In 11 patients with tumor of the posterior portion of the third ventricle, cerebrospinal fluid was collected additionally for diagnostic tests. In 9 patients with obstructive hydrocephalus concomitant third ventriculostomy was performed. In 4 patients with tumor of the interventricular foramen, the tumor mass was reduced and in 2 cases septostomy was performed. In 3 (9.4%) cases the histopathological diagnosis was descriptive and did not explain the nature of the lesion. Four biopsies resulted in persistent bleeding, in 3 patients transient memory impairments were observed, and in 1 patient an epileptic seizure occurred. Five patients needed ventriculoperitoneal shunt placement. Conclusions Endoscopic biopsy is a safe method to verify the histopathological nature of intra- and paraventricular lesions. It enables sampling of cerebrospinal fluid, reduction of tumor size, and in cases of coexisting obstructive hydrocephalus also third ventriculostomy or septostomy.

OBJECTIVEBlood vessel tortuosity may play an important role in the development of vessel abnormalities such as aneurysms. Currently, however, there are no studies analyzing the impact of brain blood vessel tortuosity on the risk of aneurysm formation. Therefore, the authors performed a computer-aided analysis of middle cerebral artery (MCA) tortuosity, especially among patients diagnosed with MCA aneurysms.METHODSAnatomy of the MCAs of 54 patients with unruptured MCA aneurysms was retrospectively analyzed, as was that of 54 sex-, age-, and vessel side–matched control patients without MCA aneurysms. From medical records, the authors obtained each patient’s medical history including previous and current diseases and medications. For each patient, they calculated the following tortuosity descriptors: relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metric (ICM).RESULTSPatients with an MCA aneurysm had significantly lower RLs (0.75 ± 0.09 vs 0.83 ± 0.08, p < 0.01), SOAMs (0.45 ± 0.10 vs 0.60 ± 0.17, p < 0.01), and PADs (0.34 ± 0.09 vs 0.50 ± 0.17, p < 0.01). They also had significantly higher TIs (0.87 ± 0.04 vs 0.81 ± 0.07, p < 0.01) and ICMs (3.07 ± 1.58 vs 2.26 ± 1.12, p < 0.01). Female patients had significantly higher RLs (0.76 ± 0.11 vs 0.80 ± 0.09, p = 0.03) than male patients.CONCLUSIONSMiddle cerebral artery aneurysm formation is strongly associated with blood vessel tortuosity parameters, which can potentially be used to screen for patients at risk for MCA aneurysm formation.

Complications occurring after neurosurgical procedures which lead to reoperations are associated with poor treatment outcomes. The aim of our study was to establish predictive factors of unplanned early reoperations after intracranial meningioma removal.We retrospectively analyzed 177 patients who underwent craniotomy due to an intracranial meningioma. Early reoperation was de ned as reoperation during the same hospital stay. We used a χ2 test for proportional values and t-test and Mann-Whitney U tests as appropriate for continuous variables. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses.A total of 13 (7.34%) patients underwent unplanned early reoperation. These patients underwent retrosigmoid craniotomies (25.00% vs. 6.40%; p = 0.047), suffered from ischemic heart disease (66.67% vs. 6.64%; p0.01) and atrial fibrillation (60.00% vs. 6.25%; p0.01), were receiving heparin (50.00% vs. 6.74%; p0.01) and anticoagulants (66.67% vs. 6.21%; p0.01) significantly more often than the general study population. In multivariate logistic regression analysis anticoagulant use (OR: 31.463; 95% CI: 1.139-868.604; p = 0.04) and retrosigmoid craniotomy (OR: 6.642; 95% CI: 1.139-38.73; p = 0.034) remained independently associated with a higher risk of early reoperation.Patients who underwent retrosigmoid craniotomy, those with a history of ischemic heart disease or atrial fibrillation and those who take heparin or anticoagulants are more likely to require early reoperation. Retrosigmoid craniotomy and anticoagulant use are independent risk factors for early reoperation.

Background The rupture of an intracranial aneurysm (IA) causes a systemic response that involves an immune/inflammatory reaction. We sought to characterize the systemic response to IA rupture. Methods We included 19 patients in the acute phase of IA rupture and 20 control subjects. Flow cytometry was used to analyze alterations in the level of mononuclear leukocytes. Cell-related parameters, including the neutrophil-to-lymphocyte ratio (NL-R), lymphocyte-to-monocyte ratio (LM-R), platelet-to-lymphocyte ratio (PL-R), and systemic immune-inflammation index (SII), were calculated, and the relationship between the analyzed hematological parameters and clinical status was investigated. Results Patients with ruptured IAs presented with significantly higher white blood cells (WBC) and neutrophil counts but lower lymphocyte counts than control subjects. NL-R and SII values were higher and the LM-R was lower in the acute phase after IA rupture. Analyzing the severity of clinical status and the outcome of patients with subarachnoid hemorrhage, we found that patients with poor clinical status, as measured by the Glasgow Coma Scale (GCS) and the Hunt and Hess scale, had significantly lower lymphocyte counts and higher NL-R, PL-R and SII values than those with good clinical status. Additionally, patients with lower GCS scores presented a lower proportion of CD3+CD4-CD8- cells. Worse outcomes assessed at discharge were associated with lower lymphocyte counts but higher PL-R values. Conclusions The current study pointed to the significance of systemic immune and inflammatory responses after IA rupture and the potential clinical utility of hematological parameters, which can be easily calculated. In particular, the role of DN T cells and the significance of the SII as a marker related to clinical status should be further investigated.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is well established for treating the motor symptoms for advanced Parkinson's disease (PD) but its effects on gastric myoelectrical activity and gastrointestinal symptoms have not been well studied. The aim of this study was to evaluate the effect of STN-DBS on gastric motility using electrogastrography (EGG).Twenty patients with PD (5 females, 15 males; mean aged 58.0 ± 9.0 years) who underwent STN-DBS were studied. EGG was performed in fasting and postprandial conditions before STN-DBS and 3 months after the surgery. We also evaluated the frequency and severity of gastrointestinal symptoms based on a structured gastrointestinal dysfunction questionnaire.After STN-DBS the percentage of normogastria (47.8 ± 20.7 vs 51.3 ± 15.1) and period dominant power (PDP) (11.8 ± 1.2 vs 12.3 ± 0.9) significantly increased, the percentage of arrhythmia decreased compared to the baseline during fasting and postprandial state. Abnormal response to a meal (power ratio of PDP1 after meal) decreased from 70% to 55% after 3 months follow-up. The abnormal EGG (the percentage of normogastria70%) decreased in both fasting (from 80% to 65% patients) and postprandial state (from 80% to 60% patients), respectively after the surgery. The most common GI symptoms reported prior to the surgery were constipation 95%, difficulty with defecation 85% and dysphagia 50%. After STN-DBS all gastrointestinal symptoms improved, the greatest improvement was observed in difficulty with defecation.Our results suggest that STN-DBS improves gastric motility as well as gastrointestinal symptoms in PD. Further studies of gastrointestinal motility in PD are warranted.

Acute subdural hematoma (aSDH) removal is one of the most commonly performed procedure in neurosurgery. Complications of those surgeries which require reoperation are associated with higher risk of poor treatment outcome. Therefore we decided to analyse potential factors which might be associated with risk of early reoperation among patients who underwent aSDH surgery.We retrospectively analysed 328 patients treated due to aSDH. From their medical records we obtained detailed medical history. Early reoperation was de ned as reoperation during the same hospital stay. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses.A total of 20 (6.09%) patients required early reoperation. Those patients had significantly higher International Normalized Ratio (INR) upon admission (1.96 ± 2.55 vs. 1.26 ± 0.50; p0.01) and significantly higher Prothrombin Time (PT) upon admission (21.84 ± 27.10 vs. 13.40 ± 3.45; p0.01). In multivariate logistic regression analysis a er adjustment for all possible confounders higher INR (OR: 1.762; 95% CI: 1.017-22.840; p = 0.045) remained independently associated with higher risk of early reoperation among patients with aSDH.Patients with higher INR and PT upon admission are at higher risk of early reoperation. Higher INR is independently associated with higher risk of early reoperation among patients with aSDH.

Female sex is associated with a greater prevalence of cerebral aneurysms. However, it also might be linked to the location and size of the aneurysm. The aim of this study was to find the link between female sex and aneurysm characteristics.Our study group consisted of 357 patients admitted to the hospital with both unruptured and ruptured aneurysms confirmed by Digital Subtraction Angiography or Computed Tomography Angiography and aneurysmal subarachnoid haemorrhage confirmed by head CT. Patients' medical records were analyzed for necessary information including, but not limited to medical history, blood test results, and aneurysm prevalence, size and location.Women constituted 232 (64.98%) of all patients. In this group, compared to males, we observed a more common occurrence of multiple aneurysms (1.35 ± 0.67 vs. 1.2 ± 0.57; p = .046) and left internal carotid artery aneurysms (25.88% vs. 13.93%; p .01). Anterior communicating artery aneurysms were less common (17.11% vs. 31.15%; p .01). Women also had lower dome-to-neck ratios (2.16 ± 0.82 vs. 2.82 ± 1.92; p .01), were less likely to be smokers (53.6% vs. 33.19%; p .01) and smoked fewer cigarettes per day (15.09 ± 6.62 vs. 21.09 ± 11.08; p 0.01).Female patients have a greater risk of multiple aneurysms and left internal carotid artery aneurysms, but a lower risk of anterior communicating artery aneurysms.

Health-related quality of life (HRQoL) plays a role as a patient-centered meaningful endpoint, assessing the direct clinical benefit for a patient. The inclusion of HRQoL measurements in a glioma patient may provide important data to inform clinicians on treatment decision-making. The aim of the study was to evaluate cognitive decline and HRQoL in the clinical care of a patient following neurosurgery on of glioblastoma multiforme (GBM). A 69-year-old female developed malignant brain glioma in the right temporal-occipital area; this being confirmed by CT and MR study and neuropathological findings. She had complained of headaches, dizziness, nausea, vomiting as well as attention and memory loss, and anxiety, sadness and a slowing down in the performance of daily activities. The symptoms rapidly became worse and she was referred to a neurosurgery department for consultation. She was successfully neurosurgically operated on. She was examined with the use of ne uro psycho logical tests three times: the first examination was conducted before the neurosurgical operation, the second two weeks after, and the third half year after the neurosurgical operation. In the first examination by the standard Polish version of the Mindstreams™ Interactive Computer Tests disturbances for all the tested cognitive functions occurred. The greatest changes were to occur however in the areas of visual-spatial functions. attention, executive functions and memory. In the second test, a return to the norm was achieved for the disturbed cognitive and executive functions. In the third examination (half a year after the neurosurgical operation), the cognitive and executive functions were still not bad, but had slightly decreased. Similar trend was observed in HRQoL. A significant difference in the health profile between the 1 st and 2 nd as well as between 1 st and 3 rd examination was detected for the eight SF-36 domains - HRQoL was improved. While only slight but no significant changes occurred between 2 nd and 3 rd examination. HRQoL was still not bad, but had slightly decreased. The patient after the neurosurgical operation of glioblastoma multiforme (GBM) is capable of carrying out daily activities, but shows some level of reduced complains for functional capacity, pain, general health and vitality, emotional and social functioning for mental health which has led to the impaired HRQoL.

Background: The recurrence rate of chronic subdural hematoma (cSDH) is high and early reoperation is often required. Aim: The aim of this study was to evaluate prognostic factors for early reoperation of chronic subdural hematomas (cSDH) treated by classical and minimally invasive approach. Materials and Methods: We retrospectively analyzed the medical history of 355 cSDH patients treated with formal craniotomy and minimally invasive burr hole craniostomy. We determined the potential predictors of early reoperations. Results: A total of 33 (9.3%) patients required early reoperation. Those patients more often underwent craniotomies instead of burr hole craniostomies (36.4% vs. 62.7%, p < 0.01) and took steroids before hospitalization (3.0% vs. 0.3%, p = 0.04) than non-reoperated patients. Patients who had surgery on the right side were less likely to be reoperated (51.9% vs. 33.3%, p = 0.04). On multivariate analysis the frontal (OR = 5.284, 95% CI: 1.293–21.76, p = 0.019) and large craniotomy (OR = 2.297, 95% CI: 1.004–5.258, p = 0.048) remained independent risk factors for early reoperation of cSDH. Conclusions: Neurosurgeons should consider the evacuation of a cSDH with help of minimally invasive burr hole craniostomy in most of the cases, as well as avoid large and frontal and craniotomies in order to prevent early reoperation of cSDH.

The article presents a prototype of a robot control system for stereotactic brain surgery. The development of neuroimaging, as well as the implementation of modern devices for neurosurgery, has undoubtedly contributed to significant progress in this field of medicine. Reaching a pathology located deep inside does not pose significant difficulty from the technical point of view; it is the selection of the access route that is the problem - to prevent the occurrence of permanent neurological deficits, such as severe paresis, vision disorders, speech or consciousness disorders. Obviously, knowledge of brain anatomy allows for adopting appropriate surgical tactics; however, some patients with a high-risk access route are not qualified for surgery. Even the hand of the most skilled operator does not guarantee precise removal of the tumour whilst bypassing important neural pathways, hence the necessity of introducing robots, which increase the level of surgical precision. A neural surgeon is able to perform very complicated surgical actions; however, human psychophysical limitations in neurosurgical procedures are becoming increasingly important, as surgeons are more and more frequently willing to perform operations with accuracy higher than 1 mm, but this is virtually impossible without any enhancement. Apart from the natural limitations of precision of the human hand, the surgeon's mental and physical condition deteriorates during a several-hour-long surgical procedure, thus lowering the surgeon's fitness and precision of movement. High concentration and a frequently unnatural position during the surgery cause additional tiredness. Therefore, numerous research centres and commercial companies are working on surgical robots. It seems that neurosurgery is particularly inclined for the introduction of robots enhancing the precision of a surgeon's work.

Spinal cord cavernous malformations (scCM) are rare vascular malformation representing approximately 5-12% of all intramedullary lesions. The authors reviewed over 20 publications available and have consolidated existing knowledge on the pathology, epidemiology, clinical and radiological characteristics scCM. scCM management and treatment methods have been outlined concisely and achieved outcomes have been presented. The average age of onset is 42 years without sexual predilections. scCM statistically most commonly occur in the thoracic region--57%, in 9% of patients familiar prevalence is present, in 27% of patients the co-existence of intracerebral vascular malformation is diagnosed. The most common clinical symptoms are the sensory and motor deficits (respectively 65% and 63%). The course of the disease in 54% of cases, is a progressive, slow neurologic deterioration, although it is also observed a rapid onset associated with cavernoma hemorrhage. The risk of hemorrhage is estimated at 2.5% annually. scCM that are located intramedullary, are asymptomatic should be the subject to observation. Cavernomas that are symptomatic, having contact with the surface of spinal cord or exophytic should be subject to surgical treatment that is intended to complete removal. Results of surgical treatment are satisfactory, in about 60% of patients clinical improvement has been observed.

Autonomic dysfunctions are the most common non-motor symptoms of Parkinson's disease (PD) and often precede the motor symptoms of the disease. Autonomic dysfunction may be a dominant symptom of the advanced stages of PD as well as a major cause of patient disability. Despite the wide use of neurostimulation in clinical practice, the effect of deep brain stimulation of subthalamic nucleus (STN DBS) on autonomic symptoms of PD still remains only partially understood. The aim of the study is evaluation of heart rate variability (HRV) and blood pressure variability (BPV) in patients with PD before STN DBS and following bilateral STN DBS.The study included 25 subjects aged between 31 and 71 years, diagnosed with the idiopathic PD and selected for treatment with STN DBS. All the patients were in advanced stages of PD, disease duration ranged from 5 to 22 years. The patients enrolled into this study underwent STN DBS. Neurological examination including assessment of the severity of parkinsonism according to UPDRS scale, a psychological examination and an electrophysiological examination of autonomic disturbances based on heart rate and blood pressure variability were conducted on all patients two weeks before and three months after STN DBS.After STN DBS an improvement in terms of the analyzed parts of the UPDRS has been shown. The improvement of motor disorders assessed by III part UPDRS during the "off" medication/stimulation "on" was 67.8%. Orthostatic hypotension before the STN DBS procedure was observed in 56% of patients and after STN DBS in 53% of them. Before STN DBS the imbalance of the sympathetic--parasympathetic components with the predominance of the sympathetic based on HRV parameters--the ratio LF/HF-RRI (2.5) and a higher rate of LFnu (61.3%) than HFnu (38.6%) has been shown. Three months post STN DBS an increase parameters of spectral analysis of HRV in the low frequency LF-RRI, and high-frequency HF-RRI and the total power spectrum PSD-RRI was observed. After STN DBS an increase of parameters of spectral analysis of systolic BPV, very low frequency VLF-sBP, low frequency LF-sBP and total power spectrum PSD-sBP was noted.Results of the study suggest that STN DBS is an effective treatment method of both motor symptoms and autonomic dysfunctions. The disturbances of HRV and BPV before and after STN DBS indicate the increase of autonomic system activity with sympathetic dominance.

Dissection of the internal carotid artery (ICA) is a rare disease, but in young patients is responsible for about 20% of cerebral events. We presented three different cases of ICA dissection, including one iatrogenic and two spontaneous ones, which were successfully managed endovascularly, with the use of different techniques, different protection devices and stents. In this article, the clinical management and details of procedures were described.

Summary Background Most patients with large focal skull bone loss after craniectomy are referred for cranioplasty. Reverse engineering is a technology which creates a computer-aided design (CAD) model of a real structure. Rapid prototyping is a technology which produces physical objects from virtual CAD models. The aim of this study was to assess the clinical usefulness of these technologies in cranioplasty prosthesis manufacturing. Material/Methods CT was performed on 19 patients with focal skull bone loss after craniectomy, using a dedicated protocol. A material model of skull deficit was produced using computer numerical control (CNC) milling, and individually pre-operatively adjusted polypropylene-polyester prosthesis was prepared. In a control group of 20 patients a prosthesis was manually adjusted to each patient by a neurosurgeon during surgery, without using CT-based reverse engineering/rapid prototyping. In each case, the prosthesis was implanted into the patient. The mean operating times in both groups were compared. Results In the group of patients with reverse engineering/rapid prototyping-based cranioplasty, the mean operating time was shorter (120.3 min) compared to that in the control group (136.5 min). The neurosurgeons found the new technology particularly useful in more complicated bone deficits with different curvatures in various planes. Conclusions Reverse engineering and rapid prototyping may reduce the time needed for cranioplasty neurosurgery and improve the prosthesis fitting. Such technologies may utilize data obtained by commonly used spiral CT scanners. The manufacturing of individually adjusted prostheses should be commonly used in patients planned for cranioplasty with synthetic material.

Pera J, Dziedzic T, Adamski M, Jagiella J, Krupa M, Moskala M, Szczudlik A, Slowik A. Interleukin 6–174G>C polymorphism and risk of aneurysmal subarachnoid hemorrhage: case–control study and meta-analysis. Acta Neurol Scand: 2012: 125: 111–115. © 2011 John Wiley & Sons A/S. Objectives – Vascular inflammation contributes to the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH). Interleukin 6 (IL6) is a proinflammatory cytokine involved in many vascular pathologies. Two studies analyzing an association of the functional IL6 gene –174G>C promoter polymorphism with aSAH provided inconsistent results. The aim of this study was to investigate whether this IL6 polymorphism is associated with aSAH in a Polish population. Material and methods – We genotyped 276 aSAH patients and 581 unrelated control subjects. All were of Caucasian origin. In addition, a meta-analysis combining results of the current and previously published studies was conducted. Results – The distribution of IL6 genotypes and alleles did not differ significantly between aSAH (GG – 29.7%, GC – 50.0%, CC – 20.2%, G – 54.7%) and control subjects (GG – 32.0%, GC – 47.3%, CC – 20.7%, G – 44.3%). In the meta-analysis, the IL6–174G>C polymorphism was not associated with aSAH risk either. Conclusions – We failed to find an association between the IL6 -174G>C polymorphism and aSAH in analyzed European populations.

ficiency of chemotherapy of malignant gliomas may be combined administration of alkylating agents and those targeted at epithelial growth factor receptor (EGFR). The patients eligible for such therapy should show hypermethylation of MGMT (O6-methylguanineDNA-methyltransferase) promoter as well as amplification of EGFR. Aim of the study: Preliminary assessment of frequency of MGMT hypermethylation and amplification of EGFR co-occurrence in malignant gliomas in patients diagnosed and operated on in the Neurosurgery Department, JUMC in Cracow. Material and methods: 21 consecutive cases of glioblastoma multiforme (W 65%, M 35%, age average 51 y). The methylation status of the MGMT promoter was determined by methylationspecific PCR (MS-PCR). Before MS-PCR, genomic DNA was treated with sodium bisulphite, purified, denatured, precipitated and eluted. EGFR amplification was investigated using the FISH method. Results: With regards to MGMT methylation status and the occurrence of EGFR amplification, four groups of tumours (patients) were established: I – hypermethylation and amplification (4/21, 19.04%); II – hypermethylation, no amplification (6/21, 28.6%); III – no hypermethylation with amplification (4/21, 19.04%); IV – no hypermethylation, no amplification (7/21, 33.3%). Conclusions: Theoretically almost one fifth (19%) of patients with glioblastoma multiforme, i.e. those featuring MGMT hypermethylation and EGFR amplification, could potentially benefit from bimodal chemotherapy with an alkylating agent and an EGFR blocker. Our results confirm other reports indicating that there are no relations between MGMT methylation and EGFR amplification. Financial support by Grant No. K/ZDS/ 001044 Jagiellonian Univ.

Streszczenie Wentrykulostomia komory III jest najcześciej wykonywaną operacją neuroendoskopową, ktora moze przywrocic zblizone do fizjologicznych warunki krązenia plynu mozgowo-rdzeniowego w wodoglowiu obturacyjnym. Wśrod ponad 70 doroslych chorych poddanych zabiegowi autorzy zanotowali jeden przypadek samoistnej wentrykulostomii komory III. W piśmiennictwie znaleziono kilka doniesien opisujących samoistną wentrykulostomic wykazaną w roznych badaniach: w wentrykulografii, fazowo-kontrastowym badaniu rezonansu magnetycznego (RM) w opcji kinowej i autopsyjnie. Czterdziestotrzyletnią kobiete z klinicznymi objawami wodoglowia i radiologicznymi cechami przewleklego wodoglowia obturacyjnego spowodowanego zwezeniem wodociągu zakwalifikowano do wentrykulostomii komory III. W trakcie zabiegu stwierdzono, ze trojkąt lejkowo-suteczkowy byl rozciągniety, a jego struktury nieobecne. W przebiegu pooperacyjnym obserwowano krotkotrwalą poprawe stanu chorej przy niezmienionym obrazie radiologicznym. Po 3 tyg. wobec nawrotu objawow wodoglowia wykonano test infuzyjny, ktory wykazal podwyzszony opor resorpcji. Dobry efekt przynioslo zalozenie drenazu wewnetrznego. Samoistną wentrykulostomie nalezy miec na uwadze podczas kwalifikacji chorych do operacyjnej wentrykulostomii, zwlaszcza w przypadkach z przewleklym przebiegiem wodoglowia obturacyjnego.

The morphology of the outer and inner membranes of traumatic chronic subdural hematomas (CSDHs) surgically removed from eight patients was investigated by scanning electron microscopy (SEM). Hematomas were divided into three groups based on time that had passed from the initiation of trauma to surgery. Structure of the CSDHs showed gradual morphological changes of the developing hematoma capsule. They initially included angiogenic and aseptic inflammatory reactions followed by progressive involvement of fibroblasts—proliferating and producing collagen fibrils. Numerous capillaries suggesting formation of new blood vessels were observed mainly in young hematomas removed between 15 and 21 days after trauma. In “older” hematomas (40 days after trauma), more numerous capillaries and thin-walled sinusoids were accompanied by patent, larger diameter blood vessels. Within the fibrotic outer membrane of the “oldest” hematoma capsules (60 or more days after trauma), especially in the area over the hematoma cavity, blood vessels were frequently occluded by clots. The results suggest dynamic changes in cellular and vascular organization of traumatic CSDH capsules paralleling the progression in hematoma age.

Summary Aim Craniofacial resection provides multidirectional approaches to remove nasal and paranasal tumours that involve the skull base. Vital structures, such as the dura, brain, and blood vessels, can be protected or resected and reconstructed safely. An en bloc excision of the tumour can be accomplished. The purpose of this study was to analyse oncological and functional results of craniofacial resection in our series of patients. Material and methods The medical records of 40 consecutive patients who had undergone craniofacial resection for tumours of the nasal cavity, paranasal sinuses, and adjacent areas were reviewed. The extent of disease, treatment results (the length of disease-free survival), complications, and prognoses were analysed. Results Lesions were malignant in 7 patients and benign in the remaining 33. All the patients had dural or intradural involvement. There was no operative death, and the rate of surgical morbidity was 20%. Craniofacial resection is the only surgical approach with acceptable rate of complications in selected patients with tumour comprising the anterior and medial cranial base, nasal cavity, paranasal sinuses, nasopharynx and orbits. Heroic resections are modern surgical procedures challenging both for ENT surgeons and neurosurgeons. The result is satisfactory when they are performed by a multi-specialist team.

Introduction: Recently the role of adaptive immunity has been implied by microarray studies. But the results are contradictory. T-cell infiltration is a frequent histological finding in ruptured IA, T-cell phenotype, characteristic and true quantitation remains unknown. We preformed a prospective study to determine the subpopulation and expression of activation markers of T-cells infiltrating ruptured IA in relation to peripheral blood. Hypothesis: IA have different subsets and activation levels of T-cells than peripheral blood. Methods: We collected the tissue of ruptured IA of 8 patients operated on within 24 hours after subarachnoid hemorrhage symptoms onset. IA tissue was digested, stained with fluorescently labeled monoclonal antibodies and submitted to flow cytometry. In addition we collected and analyzed venous blood from 6 age, sex and risk factor-matched controls. Results: CD4+ cells are less prevalent in IA tissue than in peripheral blood (42.14±17.28 vs. 65.88±5.32%; p=0.011), while there was no difference in CD8+ T-cells infiltrating IA (30.28±9.07 vs. 27.78±5.45%; p=0.585), and double negative (CD4-CD8-CD3+) T-cells were more prevalent in wall of IA than in circulation, (15.68±11.94 vs. 2.81±1.32%; p=0.026). Importantly, CD4+ infiltrating IA wall showed higher expression of HLA-DR (25.9±6.42 vs. 9.19± 3.58%; p Conclusion: The tissue of ruptured IA is highly infiltrated by T-cells which show high expression of activation markers such as CD69 or HLA-DR. The importance of these cells to immunopathogenesis of intracranial aneurysm rupture should be further characterized.

The aim of the study was to evaluate the effectiveness of individually tailored anodal tDCs/ neurofeedback protocol for the reduction of post-operative depression after a neuroophtalmological operation of the meningioma. The neuromarkers in Quantitative EEG (QEEG) and Event-related potentials (ERPs) were utilized in the construction of protocol and evaluation. Case description. A 45-year-old female after successful neuro-ophthalmic surgery of the meningioma, complained of severe pain and anxiety, difficulties with sleeping, attention and memory problems, as well as inability to continue working in her given profession. Neuropsychological testing showed lack of cognitive disturbances and post-operative depression. Two working hypotheses were tested to find neuromarkers of depression and anxiety. In line with the ‘depression hypothesis’ a frontal alpha asymmetry pattern was found in the patient, and in line with the ‘anxiety’ hypothesis an increased left temporal P1 wave in response to visual stimuli was found in ERPs. A specific alpha asymmetry neurofeedback protocol combined with an anodal tDCS was suggested. Twenty sessions of individually-tailored anodal tDCs/ neurofeedback protocol were performed. The QEEG frontal asymmetry pattern and the excessive temporal P1 wave were normalized after the intervention. Conclusions.The patient recovered from post-operative depression and returned to work after 20 sessions of the combined neurofeedback/tDCS protocol. Specific patterns of QEEG and ERPs serve as neuromarkers for constructing the protocol and for monitoring the results of intervention. Attribution-NonCommercial 3.0 Poland (CC BY-NC 3.0 PL)

Glioblastoma multiforme is the most common and most lethal pri- mary malignant tumor of the central nervous system. It can develop as a primary tumor or by transformation from its precursor--anaplastic astrocytoma which occurs less frequently but the prognosis is also unfavorable. Authors report a case of a 36-year-old man with "astrocytoma malignum in glioblastoma multiforme vertens" in the left frontal lobe. The mass, around 5 cm in diameter was resected by craniotomy 8 years ago. The patient received adiuvant radiation therapy concomitanly with temozolomide. He still stays asymptomatic, with no focal neurologic defects. There is no recurrence in the magnetic resonance imaging.

In the paper there have been presented the creation and activities of the Clinic of Neuropsychiatry in the period of 1914-1950 and the scientific and organizational work of professor J. Piltz (1870-1930).

Intracranial hypertension is a common life-threatening syndrome caused by a variety of neurological and non-neurological diseases. Enlargement of the optic nerve sheath has been described in patients with raised intracranial pressure (ICP). Optic nerve sonography offers rapid bedside assessment of the optic nerve sheath diameter (ONSD) and has recently been introduced for the noninvasive detection of raised ICP. This study explains the pathophysiology of optic nerve sheath enlargement as a result of intracranial hypertension, describes the technique and clinical use of optic nerve sonography.

Introduction: After a time of domination of shunt placement, endoscopic third ventriculostomy (ETV) has been in- creasingly applied in treatment of obstructive hydrocephalus. Aim: To assess the effectiveness of ETV in treatment of adults with three-ventricle hydrocephalus of different etiology. Material and methods: Ninety-six patients with obstructive hydrocephalus were studied: 24 with primary aque- ductal stenosis, 61 with brain tumor, and 2 with basilar tip aneurysm. In 9 patients the etiology of hydrocephalus remained undetermined. The assessment of treatment results was based on clinical and radiological criteria. Results: Clinical improvement was observed in 74 (77.1%) patients, and radiological improvement in 52 (54.2%). One patient died. Follow-up of 24 patients with primary aqueductal stenosis has shown that in 20 (83.3%) of them clin- ical improvement has been stable, and in 14 (58.3%) radiological improvement has been observed. Two patients re- quired shunt placement due to hydrocephalus recurrence 12-24 months after the ETV procedure. Among 9 patients with undefined hydrocephalus, 3 required shunt placement within 6 months after ETV (2 shunted previously). Endo- scopic third ventriculostomy treatment in a patient with hydrocephalus caused by basilar tip aneurysm succeeded. The assessment of ETV effectiveness in oncological patients has been indirect in view of the underlying disease. Conclusions: The best results of ETV treatment have been demonstrated for patients with primary aqueductal ste- nosis. Ventricle size cannot determine the effectiveness of treatment as an individual requirement. Endoscopic third ventriculostomy is effective in previously shunted patients although the prediction of outcome should be cautious. Endoscopic third ventriculostomy enables preparation for further therapy and is palliative treatment in oncological patients with secondary hydrocephalus.

Background and Purpose— Common variants have been identified using genome-wide association studies which contribute to intracranial aneurysms (IA) susceptibility. However, it is clear that the variants identified to date do not account for the estimated genetic contribution to disease risk. Methods— Initial analysis was performed in a discovery sample of 2617 IA cases and 2548 controls of white ancestry. Novel chromosomal regions meeting genome-wide significance were further tested for association in 2 independent replication samples: Dutch (717 cases; 3004 controls) and Finnish (799 cases; 2317 controls). A meta-analysis was performed to combine the results from the 3 studies for key chromosomal regions of interest. Results— Genome-wide evidence of association was detected in the discovery sample on chromosome 9 ( CDKN2BAS ; rs10733376: P −11 ), in a gene previously associated with IA. A novel region on chromosome 7, near HDAC9 , was associated with IA (rs10230207; P =4.14×10 −8 ). This association replicated in the Dutch sample ( P =0.01) but failed to show association in the Finnish sample ( P =0.25). Meta-analysis results of the 3 cohorts reached statistical significant ( P =9.91×10 −10 ). Conclusions— We detected a novel region associated with IA susceptibility that was replicated in an independent Dutch sample. This region on chromosome 7 has been previously associated with ischemic stroke and the large vessel stroke occlusive subtype (including HDAC9 ), suggesting a possible genetic link between this stroke subtype and IA.

The molecular mechanisms underlying the systemic response to subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms (RAs) are not fully understood. We investigated whether the analysis of gene expression in peripheral blood could provide clinically relevant information regarding the biologic consequences of SAH. Transcriptomics were performed using Illumina HumanHT-12v4 microarrays for 43 RA patients and 18 controls (C). Differentially expressed transcripts were analyzed for overrepresented functional groups and blood cell type-specific gene expression. The set of differentially expressed transcripts was validated using quantitative polymerase chain reaction in an independent group of subjects (15 RA patients and 14 C). There were 135 differentially expressed genes (false discovery rate ≤1%, absolute fold change ≤1.7): the abundant levels of 78 mRNAs increased and 57 mRNAs decreased. Among RA patients, transcripts specific to T lymphocyte subpopulations were downregulated, whereas those related to monocytes and neutrophils were upregulated. Expression profiles of a set of 16 genes and lymphocyte-to-monocyte-and-neutrophil gene expression ratios distinguished RA patients from C. These results indicate that SAH from RAs strongly influences the transcription profiles of blood cells. A specific pattern of these changes suggests suppression in lymphocyte response and enhancements in monocyte and neutrophil activities. This is probably related to the immunodepression observed in SAH.

Background and purpose The common treatment in patients with newly diagnosed glioblastoma multiforme is the ultimately radical surgical removal of the tumour combined with radiotherapy. This study compared safety and efficacy of radiotherapy alone with radiotherapy combined with temozolomide (TMZ) given before, during, and after radiotherapy. Material and methods The patients operated on for glioblastoma multiforme during the first 21 postoperative days were randomly assigned to the group treated with radiotherapy alone (involved-field radiotherapy in 2 Gy fractions daily five times a week up to the total of 60 Gy over 6 weeks of treatment) or to the group treated with radiotherapy and TMZ, initially in the dose of 200 mg/m 2 during 5 postoperative days and after 23 days followed by 75 mg/m 2 of body surface area daily, 7 days a week (from the first to the last day of radiotherapy). On completion of radiotherapy, five complementary courses of TMZ were introduced (150–200 mg/m 2 for 5 days, repeated every 28 days). The primary outcome measure was overall survival. Results Fifty-eight patients from 3 centres were included in the study. The mean age of patients was 55 years and all the patients underwent a surgical procedure of glioblastoma removal. The mean overall survival in the group treated with TMZ was 16.0 months, whereas in the group with radiotherapy alone the overall survival reached 12.5 months. 24-month survival reached 23% in patients treated with TMZ and 6.7% in those who received radiotherapy only. Haematological complications of third or fourth degree were present in 10% of patients treated with radiotherapy and TMZ. Conclusions The introduction of TMZ before, during and after radiotherapy for newly diagnosed glioblastoma multiforme gives clinically and statistically significant improvement of survival with unremarkably increased toxicity of the treatment.

Nine cases of posttraumatic primary brain stem haematoma are described. All cases presented ocular and vegetative symptoms. Hyperextension was regarded as the most likely mechanism of injury. All patients were treated conservatively; half of them with a good outcome.

Background Recent clinical studies have shown that the dorsal motor nucleus of the vagus nerve is one of the brain areas that are the earliest affected by α-synuclein and Lewy body pathology in Parkinson's disease. This observation raises the question: how the vagus nerve dysfunction affects the dopamine system in the brain? Methods The rats underwent surgical implantation of the microchip (MC) in the abdominal region of the vagus. In this study, we examined the effect of chronic, unilateral electrical stimulation of the left nerve vagus, of two different types: low-frequency (MCL) and physiological stimulation (MCPh) on the dopamine and serotonin metabolism determined by high-pressure chromatography with electrochemical detection in rat brain structures. Results MCL electrical stimulation of the left nerve vagus in contrast to MCPh stimulation, produced a significant inhibition of dopamine system in rat brain structures. Ex vivo biochemical experiments clearly suggest that MCL opposite to MCPh impaired the function of dopamine system similarly to vagotomy. Conclusion We suggest a close relationship between the peripheral vagus nerve impairment and the inhibition of dopamine system in the brain structures. This is the first report of such relationship which may suggest that mental changes (pro-depressive) could occur in the first stage of Parkinson's disease far ahead of motor impairment.

The aim of this study was to evaluate the impact of modern methods in surgical treatment of skull base tumors (multidisciplinary operating teams, new methods of dura and bone defects repair) on extension of tumor resection considering complications rate.The retrospective study for 26 patients of Neurotraumatology Department, Jagiellonian University Collegium Medicum was carried out. All of patients were operated due to skull base tumor in period 2003 - 2006. In our series 9 patients (34.62%) was admitted with recurrence of skull base pathology. The age average for the sample was 57.38 +/- 14.84 years.In 16 cases (61.54%) dura was involved in pathological process. Every time if dura resection was performed, the resulting defect was repaired with Tachocomb, tissue glue, artificial meninge, fascia lata femoris, pericranium. In case of bone infiltration (especially in anterior fossa of the skull), the resection was followed by the cranioplasty (Norian, cranioplast) - prevention of brain herniation, and opened during the operation sinuses were closed with use of temporal muscle and biomaterials. 15 patients (57.69%) were operated in mixed multidisciplinary teams (cooperation with Maxillofacial Surgery and Otorhinolaryngology Department). The resection of pathological mass was evaluated as completed in 69.23% (n=18) cases. The most common histopathological finding was neoplasm from meninges: 11 (42.31%) and epithelial neoplasm 7 (26.92%).The modern micro- and neurosurgical techniques, new reconstructive methods of dura and bone defects (biomaterials) and multidisciplinary operating teams (craniofacial approach) diminished limitations for extended resection of tumors in very complexed area that skull base is, by complications on accepted level. Typical for skull base tumors' treatment is varied histopathological nature of mass lesions, what in relation to grading of tumors still has the strongest impact on long term results of treatment.

Background: The aim of present article is to compare patients with damage to the orbitofrontal cortex and prison inmates in terms of social intelligence and social intelligence monitoring. In addition, personal principles and emotional regulation of behavior will be assessed in both groups. Material/Methods: 20 patients with orbitofrontal cortical injury, 20 prisoners and 20 controls answered questions from the Social Interactions Assessment Questionnaire. Then they evaluated their self-disclosure, reported their emotions related to self-disclosure and declared their personal principles concerning conversations with strangers. Results: The patients with damage to the orbitofrontal cortex disclosed themselves to a stranger less appropriately than did other subjects, and did not assess it critically. They also violated their own declared principles, but did not feel embarrassed because of that. The prison inmates spoke out less forthrightly on many topics and felt confused during the whole examination. Conclusions: Damage to the the orbital part of frontal lobes may result in a disorder of self-disclosure monitoring and impairment of social intelligence in conversations with unknown persons. Prison inmates give information about themselves unwillingly, which may result from their specific experiences during criminal and judicatory procedures and confinement. Language: en

Spinal canal tumours constitute a minor part of CNS invading neoplasm. However, due to their damaging influence on the spinal cord and the spinal roots, they cause serious clinical problems and can lead to severe disability. The aim of this study is to review material collected on tumours of the spine and the spinal canal at the Department of Neuropathology over the past ten years.One hundred and eighty five histopathological examinations of spinal tumours were evaluated between August 1997 and August 2007. The group of patients included 94 females and 91 males between the age of 18 and 79 years with a mean age of 53.Apart from typical intraspinal tumours (i.e. astrocytomas and ependymomas), and extraspinal tumours, (i.e. meningiomas, schwannomas, neurofibromas), rare neoplastic and non-neoplastic tumour-like changes occur in the same localizations. These rare conditions include: capillary haemangioma, paraganglioma of filum terminale, meningeal gliomatosis, different variants of cysts such as the dermoid cyst, synovial cyst and aneurysmatic bone cyst, neoplastic and non-neoplastic bone tumours like the giant cell tumour, chordomas, and intramedullary metastatic carcinomas.This paper presents and discusses spinal lesions from collected data with special attention paid to the rare conditions, which are reviewed in more detail.

The study describes an innovative method in which a photon needle (IF) is used for surgical treatment of the primary and metastatic brain tumours. The article comprises information on the principles of operation of a photon needle, with description of an auxiliary equipment supporting the needle operation and a procedure used in control of the needle before sterilisation. Moreover, individual stages of the needle testing program were described with indications to the future process of radiotherapy.

Deep brain stimulation (DBS) for alleviation of motor symptoms in advanced Parkinson's disease (PD) is well established. However, autonomic effects of DBS are less clear.To review published data on autonomic dysfunctions in DBS-treated patients with PD.Medline bibliographic search was performed with the selected relevant keywords, through June 10th, 2010. Thirty three original papers meeting the criteria were identified.Effect of DBS on autonomic dysfunctions observed in PD differs depending on the underlying etiology. DBS of the subthalamic nucleus has no direct effects on cardiovascular functions. Relative improvement results from reduced levodopa intake. Majority of gastrointestinal and urinary tract disorders improve with neurostimulation. However, prolonged body weight gain is observed. Furthermore, urinary tract functions normalize, and in male patients with Parkinson's disease sexual satisfaction increases. Sweating disorders are markedly reduced. On the contrary, chronic stimulation in the area of STN may induce autonomic adverse effects including sialorrhea and urinary retention. In exceptional cases withdrawal of medication before planned DBS surgery may result in life-threatening parkinsonism-hyperpyrexia syndrome. Thus discontinuation of levodopa should be an inpatient procedure.Selection of patients who undergo DBS should weigh potential benefits and risks resulting from multidirectional effects of neurostimulation on autonomic nervous system.

It seems to be generally believed that early neurostimulation after severe TBI is useless or even harmful, and neuropsychological intervention should not be initiated until the patient is medically stable. On the other hand, the unstimulated brain can incur irreversible damage. The purpose of the present study is to assess the impact of early neuropsychological rehabilitation on a patient with an extremely severe TBI.The patient, a 32-year old male, suffered a massive cranio-facial injury with significant loss of tissue in the right frontal lobes after being struck by a tram. Beginning two weeks after injury, after pharmacological coma, he was attended on a daily basis by a neuropsychologist and a neurolinguist, with the active assistance of his family, when he was still in critical condition and essentially without logical contact. By the time he returned to Scotland 4 weeks later, he was sitting up, writing complete, sensible and grammatical sentences, and making rapid progress every day despite the development of hydrocephalus. Over the course of neurorehabilitation, most of MF's cognitive dysfunctions resolved. Six months later, however, hydrocephalus was increasing and the patient was showing severe frontal syndrome. A personalized version of Community Based Rehabilitation was applied. After two weeks of intensive treatment considerable improvement was achieved and frontal syndrome was reduced.The present case suggests that the prevailing views regarding the inadvisability of early neurorehabilitation in the acute phase after TBI should be reconsidered.

Third ventriculostomy (TV) is the most common neuroendoscopic procedure for restoration of near physiological circulation of cerebrospinal fluid in obstructive hydrocephalus. Among 70 adults operated on using this technique, the authors encountered one case of spontaneous TV. Only a few case reports of spontaneous ventriculostomy revealed by ventriculography, flow-sensitive phase-contrast cine magnetic resonance imaging (MRI) or at autopsy have been published. A 43-year-old woman with symptoms of hydrocephalus and signs of chronic obstructive hydrocephalus secondary to aqueductal stenosis on MRI was qualified for TV. Enlarged infundibulo-mammillary triangle with perforation was noted intraoperatively. During the postoperative course, the condition of the patient partially improved although radiological appearance remained unchanged. Three weeks later symptoms of hydrocephalus recurred and the patient underwent an infusion test which revealed increased cerebrospinal fluid outflow resistance. Implantation of a ventriculo-peritoneal shunt yielded stable improvement. Spontaneous TV should be taken into consideration during selection of patients for TV, especially in cases with chronic obstructive hydrocephalus.

In recent years in the Department of Neurotraumatology in Cracow it has been noticed the frequent connection between appearance of chronic subdural hematoma (CSDH) and treatment by anticoagulant medications. The aim of this study is to draw attention to the problem of insufficient control of anticoagulants consumption, especially by patients treated for cardiovascular system diseases that increases the risk of bleeding and CSDH development. The paper is based on data from questionnaires that was sent to patients with CSDH, cured in the Department of Neurotraumatology form 2004 to 2005. Analyzed was the group of 51 patients with chronic subdural hematoma; 37 individuals (72.5%) confirmed taking acetylsalicylic acid in the period of 3 months before admission to the Department, 9 (17.6%) patients answered that they were taking low-molecular weight heparin. One patient (1.9%) was taking chronically derivative of cumarin. The authors would inform that anticoagulant treatment might favour increase of chronic subdural hematoma incidence. It's especially important, because the average life expectancy has been prolonged in Poland and there are more people taking acetylsalicylic acid. This can be an epidemiological problem in future.

Background and Purpose— Mechanisms underlying development and rupture of intracranial aneurysms (IA) are poorly recognized. The majority of studies on human tissue have focused on predefined pathways. We sought to analyze global gene expression patterns of ruptured IA, unruptured IA, and control vessels. Methods— Transcription profiles were studied in human ruptured (n=8) and unruptured (n=6) IA, as well as in control intracranial arteries (n=5), using oligonucleotide microarrays. Real-time reverse-transcription polymerase chain reaction was used for confirmation. Functional analysis for determination of over-represented ontological groups among gene expression profiles was also performed. Results— The expression of 159 genes differed among the studied groups. Compared to the controls, 131 genes showed common directions of change in both IA groups. The most impacted biological processes for IA are: (1) the muscle system; (2) cell adhesion (downregulation); and (3) the immune system and inflammatory response (upregulation). Ruptured and unruptured IA differed in genes involved in immune/inflammatory processes; expression was reduced in ruptured IA. Conclusions— Decreased expression of genes related to muscle system and cell adhesion is important for the development of IA. The role of immune/inflammatory processes is unclear. Inflammation may participate in the healing process within IA while playing a protective role against IA rupture.