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Aim: The aim of this work was a retrospective evaluation of the safety of the supracerebellar transtentorial approach in our patient series. It represents a technically challenging approach, which we used during surgeries of the posterior and medial mediotemporal area, lateral mesencephalon and posteromedial thalamus. Materials and methods: We evaluate the series of our 8 patients, which we operated on using the supracerebellar transtentorial approach during 2013–2021. In one case, we dealt with anaplastic astrocytoma, 3× with glioblastoma multiforme primary surgery, 1× with diffuse midline H3K27M glioma, 1× with glioblastoma multiforme recurrence surgery, 1× with low-grade glioma surgery and once we operated using this approach an acutely bleeding cavernoma of the lemniscal trigone of the mesencephalon. All our patients were operated on in a semisitting position. Results: The thirty-day mortality rate of our series is zero. In case of a patient with diffuse midline H3K27M glioma which was primarily operated on in a bad neurological condition, we had to perform early revision surgery using the same approach due to residual tumor hemorrhage. In case of our first patient with extensive mediotemporal anaplastic astrocytoma, we had to add the suboccipital approach for resection radicality increase early after the first phase of surgery; after the surgery, he had superior quadrantanopsia. In one patient's case, ischemia of the occipital lobe occurred due to an intraoperatively visible lesion of the posterior cerebral artery inside the glioblastoma. After surgery, hemianopsia was present. Conclusion: The approach poses a technically challenging, but concurrently safe surgical trajectory. In case of the lesions affecting the mediotemporal area, it is advantageous for its medial and posterior part, but during the resection it is possible to reach as far as the uncus and amygdala. The prerequisite condition is accurate anatomical knowledge; in our department, we prefer the semisitting position for this approach. It is important to have a sufficient cerebrospinal fluid decompression by releasing the fluid from the cisterna magna from a separate dural incision and a gentle manipulation of the vascular structures of the tentorial incisura. [ABSTRACT FROM AUTHOR]

Aim: The aim of our work was retrospective evaluation of the resection extent of predicted and ongoing low-grade glioma (LGG) surgeries. Furthermore, we evaluated the behavior of defined residual tumors after subsequent oncological treatment in case of partial and subtotal resections. Patients and methods: We evaluated a series of our 37 patients operated on during 2010–2019 at the Department of Neurosurgery, Masaryk Hospital in Ústí nad Labem. The anatomical eloquent boundary lines were strictly defined by the primary motor and visual cortex (g. precentralis and adjacent gyri to the calcarine sulcus), including their tracts, further pars triangularus and pars opercularis of the inferior frontal gyrus as expressive language areas and the structures of the central core. No absolute eloquent region was the perisylvian cortex of the dominant hemisphere. A partial resection we defined as a presence of the tumor layer > 1 cm evaluated on T2 weighted MRI 2–4 months after surgery. Subtotal resection was defined identically as tumor layer less or equal to 1 cm. Results: As potentially possible radically resectable (YES), we evaluated an overall 25 patients (68%) in our series with: 1) six patients (16%) with a safe limit to the eloquent area (YES Safe) – in this instance we reached radical resection in all cases; 2) 19 patients (51%) with the necessity of reaching the border to the specific area (YES Risk) – in this instance we reached radical/subtotal/partial resection in 7/6/6 patients. As necessarily partially resectable (NO), we evaluated 12 patients (32%) and in this instance, we really reached partial resections in all cases. The residual tumor positively reacted to the oncological treatment in 90% of the cases, the shortest period of observation was 13 months. Major complication of the surgery occurred in one case of a female patient (2.7%). The other complications (5.4%) were mild – one case of hemianopsia and one case of a supplementary motor area lesion. Conclusion: The definition of anatomical boundaries of LGG and position of eloquent areas correspond with prediction of the extent of gained resection. However, alpha-omega of success is respecting brain arteries and veins in the surgical field. If a neurosurgeon approaches the margin of safety in an eloquent cortex and its tracts and leaves a small remnant of the tumor during the surgery, radiochemotherapy after surgery is indicated and is effective [ABSTRACT FROM AUTHOR]

Aim: Decompressive craniectomy is a method of choice in the treatment of malignant middle cerebral artery infarction. Based on the conclusions of the three European prospective trials DECIMAL, DESTINY and HAMLET and their pooled analysis, we performed a retrospective analysis for years 2014-2018 at our department to assess the clinical outcome of patients who underwent decompressive craniectomy for malignant middle cerebral artery infarction. Patients and methods: The set consisted of 33 patients. Results: 22 operated patients died as a result of the disease, three patients were grade 4 and four patients grade 3 on the modifi ed Rankin Scale. Four patients had to be excluded from the cohort. We monitored parameters such as the patient's age at time of stroke, the time that had elapsed since the clinical manifestation and since determination of diagnosis according to CT to the start of surgery and midline shift on CT. We performed a statistical analysis of the baseline data, but these were not entirely benefi cial for a probably small group of patients. Conclusion: In general, in line with the fi ndings of European studies, the patient's age at stroke onset (below 60 years) and the time elapsed from the clinical manifestation and from graphic signs of ischemia to the start of decompressive craniectomy (less than 48 h) are essential positive prognostic factors. [ABSTRACT FROM AUTHOR]

The authors present a monocentric retrospective study of a group of 27 patients operated for non-ruptured brain arteriovenous malformation (AVM) during years 1999-2017. The aim was to compare our results with the results of larger international studies and to draw appropriate conclusions. All patients underwent radical resection of the AVM and their clinical status was evaluated using the modifi ed Rankin scale before and after the surgery with an average 6-year follow-up. The group was represented by the AVM´s Spetzler-Martin Scale I-IV. After resection, six patients improved, one deteriorated, and the others remained in the same condition as before surgery. Our morbidity was 3.7 % and mortality was 0 %. After 16 years of follow-up, no recurrence or residual malformation were detected in any patient. Compared to foreign studies, our results for all types of AVM´s are comparable and, therefore, for the unruptured the AVM´s Spetzler-Martin I-II microsurgical approach, for the unruptured AVM´s Spetzler-Martin III microsurgical approach with possible complementary alternatives of embolization or radiotherapy and for the AVM´s Spetzler- Martin IV-V rather observation can be recommended. [ABSTRACT FROM AUTHOR]

The presented case report describes the first use of adenosine-induced transient circulatory arrest in a patient undergoing cerebral aneurysm clipping in the Czech Republic. Short episodes of circulatory arrest improved surgical conditions (as assessed by the surgeon) without any apparent complications during surgery. The cumulative length of circulatory arrest was 47 seconds; the total dose of administered adenosine was 90 mg. The postoperative course was uneventful and the patient was discharged home with a good functional status. Current scientific evidence in this field and key practical points of this technique are discussed. [ABSTRACT FROM AUTHOR]

Aim of the study: Purpose of this study is to evaluate peripheral nerve (PN) regeneration after microsurgical reconstruction in our series of PN injuries in children, to identify the best surgical technique and its timing and to describe the post-operative care and the follow-up schedule. The pitfalls and the alternate management if the primary surgical reconstruction fails are provided. Material and methods: We retrospectively evaluated a series of children treated at our institution between 1999 and 2012. In this 14-year period 67 lesions in 60 patients (45 males, 15 females) were identified. Mean age was 12.3 years. 44 injuries constituted the completely transected PN, 20 partially and 3 lesions were concluded as traction injuries. The median nerve was the most frequently severed, followed by the ulnar nerve, typically at the wrist/distal forearm. The most common cause was a fall through the glass door. 48 lesions (80%) were treated immediately, 7 (12%) in a delayed fashion and 5 (8%) late. Direct microsuture was performed in 54 (81%) lesions; exoneurolysis in 6 (9%); and the autograft interposition was used in 7 lesions (10%). Results: 26 children with 31 lesions completed 2-year follow-up period, 26 lesions in this subgroup (84%) recovered successfully (defined as motor function ≥M4 and sensory ≥S3 per B.M.R.C.). 5 (16%) recovered unsatisfactorily and in 4 of them we performed a secondary tendon transfer with good functional outcome. Conclusion: Peripheral nerves in children show remarkable regeneration capabilities and an immediate repair yields very good outcome. We advocate that the nerve repair should be performed in a timely manner to prevent more complicated reconstruction procedures with worse functional outcome. [ABSTRACT FROM AUTHOR]

Carotid web is considered to be a less common, but overlooked cause of recurrent cryptogenic ischemic stroke. It is defined as a fibromuscular dysplasia forming a shelf-like protrusion in the carotid bulb that alters regional hemodynamics with a high risk of blood clot formation and its embolization intracranially. The web could be well visualized on CTA; however, it can be missed in the absence of significant carotid stenosis or the presence of an intraluminal thrombus. Treatment includes antiplatelet therapy, but also interventions – carotid endarterectomy or endovascular stenting. The carotid web typically leads to ischemic stroke in younger patients without any other cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Rupture of an intracranial aneurysm represents a life-threatening condition with a still high mortality and morbidity. The pathogenesis of aneurysm development and eventual aneurysm rupture are still shrouded in mystery, representing a great field of research opportunities for scientists. Despite certain limitations, experimental models of intracranial aneurysms have their invaluable place. The review article summarizes the published results of current experimental rodent-focused models, their advantages, as well as limitations. At the same time, it introduces the reader to the results of our pilot study of an experimental laboratory mice model. [ABSTRACT FROM AUTHOR]

The goal of our work was to acquaint the reader-neurosurgeon with the detailed anatomy of the cerebellar tonsil, focusing on its individual surfaces. This is because, in most publications, the tonsil is presented only within the context of the anatomy of the entire cerebellar hemisphere, or possibly the anatomy of the cerebellomedullary fissure or the course of the arteria cerebelli posterior inferior. We conducted cadaveric dissections of the tonsil on 4 cerebellar hemispheres (divided sagittally in the plane of the vermis) and on one complete cerebellum with its peduncles and the floor of the fossa rhomboidea. We used this for demonstrating the telovelar approach. We believe that for the safe mastering of the telovelar approach in the operating room, laboratory dissection is mandatory. It allows the neurosurgeon to recognize even less known structures of the lateral recess, cerebellomedullary fissure, and understand the telovelar junction. In a comprehensive review, we also document individual surgeries related to the tonsil and telovelar approach: the surgery for Chiari malformation with syringomyelia, tumor of the IVth ventricle, cavernoma of its lateral recess, and cystic hemangioblastoma of the medulla oblongata. Based on literary data, we document the history of the surgical approach, which is an exemplary demonstration of the collaboration between two world-renowned neurosurgeons (Rhoton and Matsushima), and was underpinned by extensive laboratory work. In the review, we address congenital variants of cerebellar tonsil herniation (Chiari malformation) as well as secondary causes and their imaging possibilities. We mention the clinical significance of the pathological descent of tonsils and their association with syringomyelia. [ABSTRACT FROM AUTHOR]

Low-pressure hydrocephalus (LPH) is a serious disease characterized by ventricular dilatation and clinical signs of intracranial hypertension, although the pressure of the cerebrospinal fluid (CSF) in the cerebral ventricles is below the normal range. The pathophysiology of LPH remains complex and not fully understood, but it seems that a combination of mechanisms involving isolation of the ventricular system from the subarachnoid space, changes in brain tissue elasticity and compliance, and increased brain tissue permeability may play a key role. The diagnosis of LPH should be considered in patients with clinical signs of intracranial hypertension and ventricular dilatation on imaging with preserved patent CSF drainage and normal pressure settings. Treatment of LPH includes temporary therapy to ensure patient stabilization with external ventricular drainage and gradual weaning from drainage with the use of increasing intracranial pressure. Permanent treatment includes endoscopic ventriculostomy of the third ventricle and implantation of a shunt with a low differential pressure setting. The choice of the type of shunt may be individualized; only the lumbo-peritoneal type is not recommended. It should be emphasized that recognition and proper treatment of LPH are crucial, as improper treatment can lead to fatal consequences. Despite the ongoing challenges in the diagnosis and treatment of LPH, it is important that the disease is well known to the professional community. [ABSTRACT FROM AUTHOR]

Recurrence of intracranial aneurysms (IA) after surgical treatment (aneurysm clipping) is relatively rare in clinical practice. The treatment of such an aneurysm requires an individualized approach based on precise medical imaging and experience of the team. Surgical treatment of recurrent aneurysms is technically more demanding compared to primary surgery especially due to postoperative changes. The goal of this study is to review current knowledge and management of recurrent IA after clipping and present our experience with such cases. [ABSTRACT FROM AUTHOR]

Provedli jsme dalsí stimulacní test, následkem nehoz doslo k aktivaci detruzoru s charakteristickymi pulsy kontrakcí a pauz po stimulaci, po které následovalo vyprázdnení mocového mechyre ze 75 % (obr. Nasím cílem je vytvorit centrum pro implantaci Brindleyho stimulátoru a po jednání s pojistovnami získat prostredky k financování operací u indikovanych jedincu. Po peclivém komplexním vysetrení (MR pátere, urologické, interní a neurologické vysetrení) a rozvaze byl nemocny 4 roky po traumatu indikován k SDAF-SARS. [Extracted from the article]

Aim: Development of an examination protocol for investigation of functional integrity and microstructural damage of peripheral nerves (PN) at different locations using diffusion tensor imagi ng (DTI). Consequently, we want to implement this protocol into clinical practice. Subjects and methods: We investigated 15 healthy volunteers and 15 patients with a 3T MRI, scanner usi ng the DTI method. We attempted to visualize the brachial plexus, lumbosacral plexus and the course of PN in the limbs of healthy volunteers. In patients, we focused on the examination of damaged parts of the PN to display these pathologies. Results: We managed to obtain a valid visualization of the brachial plexus, lumbosacral plexus and the course of PN in the limbs us i ng DTI. Throughout the study, we encountered some limitations of this method, particularly motion artifacts which interfered with the quality of nerve structure imaging and problems in differentiating nerve fibers from muscle fibers. These technical problems could be reduced to a certain extent using adequate coils, optimizing imaging protocols and data processing methodology. Conclusion: Despite some technical limitations, this paper demonstrates the possibility of obtaini ng a valid display of PN in different locations us i ng the DTI method. DTI is an additional non-invasive imagi ng technique providi ng valuable information useful in the decision-maki ng diagnostic and therapeutic process for various PN pathologies. Technological advances and further improvements of MRI techniques in the future are likely to result in a wider use of this technique in clinical practice. [ABSTRACT FROM AUTHOR]

In short communication, we describe the anatomy of the dentate gyrus including its vascular supply. The dentate gyrus is a small gyrus of the human brain, hidden to the observer (anatomist, neurosurgeon) in the depth of the hippocampal complex. It is ejected to the ambient cistern only by its delicate teethed part. The dentate gyrus is important due to its involvement in the Andersen circuit during the creation and consolidation of the memory track. The anatomical dissection helps us to understand its position to the hippocampus proprius, what clarifies their functional connection (perforant path). This dissection is also important for the neurosurgeon, who performs amygdalohippocampectomy or resection of the mediotemporal glioma. We also deal with nosologic entities united to this complex and striking anatomical area. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is a disease in which headache is the main symptom. Recently, it has become an important part of the broad differential diagnosis of causes of headache. Advances in understanding of pathophysiology, indication of proper imaging modalities, and expansion of microsurgical techniques contributed to increased recognition of the disease. Young patients in productive age commonly suffer from SIH, and it might negatively influence both their social and professional life. Therefore, it is of great importance to recognize the symptoms of the disease and treat it properly. The aim of our article is to provide a review of the pathogenesis, current recommendations for the diagnosis and therapy of SIH. A report of a typical case should support our effort. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to portray results of meralgia paresthetica (MP) treatment at our institution, as well as a review of current surgical treatment strategies. Methods: Diagnosis of MP was made based on a combination of typical patient symptoms, negative MRI of the lumbar spine, electrophysiological and ultrasound examinations of the lateral femoral cutaneous nerve (LFCN) and a diagnostic nerve block. In cases where conservative therapy failed to improve the patient's symptoms, surgical neurolysis of LFCN was performed. In cases of unsatisfactory relief of clinical symptoms, surgical neurotomy was off ered to the patient. Results: Fifteen patients (13 males, 2 females) were surgically treated for MP from 2006 to 2020. Eleven cases were classified as idiopathic and four were classified as iatrogenic. In addition to typical pain, paresthesias and dysesthesias of the anterolateral thigh region, 13 patients presented also with hypesthesia of this region. Mean average preoperative Visual Analogue Pain Scale (VAS) was 8.4. After undergoing surgical decompression, the average postoperative VAS after one year was 2.2. Three patients were unsatisfied after surgical neurolysis (VAS over 7), all of whom had an iatrogenic cause of MP. Of these three patients, one opted for surgical neurotomy of the LFCN. Conclusion: Surgical neurolysis of the LFCN is an effective treatment for patients with MP in cases where conservative therapy fails. Neurotomy although clearly effective, was reserved for cases of failed neurolysis, as it is accompanied with permanent hypesthesia of the anterolateral thigh. [ABSTRACT FROM AUTHOR]

The fact that some brain tracts decussate accompanies medical students and neurologists and neurosurgeons during the whole period of their study, as well as in their work “careers”. We take the decussation of the pyramidal tract, anterolateral, lemniscal systems and visual pathways for granted and we describe contralateral hemipareses, hemiplegia, including alternating ones, Brown-Séquard’s spinal cord hemisyndrome and homonymous hemianopsia. We understand the central lesion of the facial nerve, presenting only with contralateral paresis of mouth muscles while the ability to close the eye is preserved. The other tracts which cross and in which we do not often realize this are for example the tracts of the dentate-rubro-olivary (Guillain-Mollaret’s) triangle, lemniscus lateralis (corpus trapezoideum) conducting hearing, tractus pontocerebellaris, and tractus dentatothalamicus (decussatio pedunculi cerebellaris superioris). The trochlear nerve, tectospinal tract (decussatio tegmenti dorsalis) and rubrospinal tract (decussation tegmenti ventralis) decussate in the mesencephalon, reticulospinal tracts are both crossed and also uncrossed and on the contrary the crossing of the interstitiospinal tract from the ncl. of Cajal and vestibulospinal tract from the ncl. of. Dieters are not present. We questioned this finding, so we conducted the review of the pertinent literature concerning the theories why the tracts cross, we added the mnemotechnic predator theory of the silur sea, and we concentrated on the phylogenetic differences in the architecture of vertebrate brains, with the help of dissection of brain cadavers from rabbit (Oryctolagus cuniculus), duck (Anas platyrhynchos domesticus) and carp (Cyprinus carpio). Based on our results, we are not able to answer all of the above-mentioned and further related questions, hence we present them to the reader in the form of a minimonography. [ABSTRACT FROM AUTHOR]

Background: An indication for selective shunting during carotid endarterectomy (CEA) is based on monitoring during a procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) may be a simple technique, but its relevance during CEA, especially with respect to cutoff values indicating shunt implantation, still needs to be elucidated. Methods: One hundred twenty five patients underwent CEA under local anesthesia (LA) and were monitored clinically throughout the whole procedure. The patients were also monitored using bilateral NIRS probes during surgery. The NIRS values were recorded and evaluated before and after selective cross-clamping, firstly by the external carotid artery (ECA), followed by the internal carotid artery (ICA). The decrease in the ipsilateral CO values, with respect to the indication of shunting, was only analyzed after selective cross-clamping of the ICA. The decision to use an intraluminal shunt was solely based on the neurological status evaluation after ICA cross-clamping. Results: One hundred five patients (85%) were stable throughout the CEA, while 20 patients (15%) clinically deteriorated during surgery. The mean drop in the CO after selective ICA clamping in clinically stable patients was 6%, while in patients with clinical deterioration, the NIRS decreased by 14.5% (p < 0.05). When the cutoff value for selective shunting was set as a 10% decrease of the ipsilateral CO after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83.0%. Conclusions: Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cutoff value for selective shunting during CEA. Despite the availability of a variety of monitoring tools, the NIRS may be an easy, reliable option, especially in the scenario of acute CEA in general anesthesia. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to analyse results of endoscopically assisted decompression of the ulnar nerve in the cubital tunnel in a substantial number of patients with cubital tunnel syndrome. Materials and methods: We analysed a set of 204 patients with the diagnosis of cubital tunnel syndrome, in whom we performed 213 endoscopically assisted decompressions of the ulnar nerve in the cubital tunnel from May 2007 until December 2016. Firstly, the patients were followed for 3 months after surgery (70% of the patients) and secondly, we evaluated long-term results based on our own questionnaire completed by 55% of patients. Results: Out of 149 followed cases (141 patients), improvement or significant improvement was found in 90% of them. Nine percent of the patients described stationary symptoms and 1% felt worse. Postoperative electrophysiological examination was performed in 137 patients. Results were as follows: improvement in 89%, no change in 10%, and worsening in 1% (N = 2) of the cases. Both of these worsening’s were temporary and subsequent electromyography showed improvement after 10 and 15 months, respectively, without a need for revision surgery also due to the improved clinical condition. We obtained the completed survey from 115 patients (121 surgeries) with a follow-up of 14–129 months, 60 months on average. Overall improvement of the operated hand was expressed by 92% of patients, while 89.5% of them described a satisfactory effect of the procedure and its course. We failed to prove a statistically significant relationship between the severity of preoperative symptoms (McGowan score or electromyography finding) and the patient’s postoperative satisfaction. On the contrary, we found a strong relationship between the patient’s satisfaction after surgery and subjective return of hand sensitivity or improvement of grip strength. Conclusion: Our study proves that endoscopically assisted decompression of the ulnar nerve in cubital tunnel represents a safe and reliable alternative to other surgical procedures of ulnar nerve decompression. With the correct indication provided, the procedure leads to long-term improvement of the symptoms of cubital tunnel syndrome in vast majority of patients, including patients with a severe nerve lesion. [ABSTRACT FROM AUTHOR]

Aim: Aim of this study was to verify the safety of an early carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) in terms of hemorrhagic, ischemic, and other complications. Material and methods: 65 CEA patients were operated after the IVT or MT. In a prospective study, hemorrhagic, ischemic, and other complications were studied and their relationship to (a) timing of the procedure; (b) antithrombotic and statin therapy; (c) blood pressure; and (d) imaging and other findings were evaluated. Results: In the group where CEA followed IVT (a) within 6 h: 2 ischemic complications (3.08%) were noted – one periprocedural and one 12 h after CEA, one wound hematoma without revision; (b) 6–12 h: one (1.54%) ischemic stroke 12 h after CEA; (c) 12–24 h: one (1.54%) ischemic stroke 16 h after CEA; (d) 24–72 h: one (1.54%) ischemic stroke 10 h after CEA and two wound hematomas (one with revision); (e) over 14 days: two transient lesions of XIIth and VIIth cranial nerves (3.08%); no postoperative intracerebral hematoma was noted. The total number of ischemic complications in the whole group was 7.7%. The only prognostic factor of postoperative ischemic complication was post-operative arterial hypotension (P = 0.001). Conclusion: Early CEA after IVT is justified to reduce the risk of relapse. The only prognostic factor of ischemic complications development was post-operative arterial hypotension. [ABSTRACT FROM AUTHOR]

Hemodynamic parameters play a significant role in the development of intracranial aneurysms and their time-depending changes during a prolonged follow-up period could lead to an increasing risk of rupture or to aneurysm rupture. The characteristics of these changes could bring significant information about the development of aneurysms and their rupture. In this unique study, we analyzed four incidental unruptured intracranial aneurysms in four patients who were followed-up for a mean period of 5 years until their rupture. We performed computational fluid dynamic simulations with the data from two or three follow-up angiographic examinations from each patient and analyzed the results with regard to time-dependent changes in terms of the values of hemodynamic parameters. Except one aneurysm of a fusiform dissecting origin, three aneurysms on MRA were described as non-growing. In the aneurysm domes, the minimal wall shear stress decreased and the low wall shear stress area increased significantly over time; the results indicated that the time-dependent changes such as decreasing values of minimal wall shear stress and increasing values of low wall shear stress area could lead to an increased risk of rupture. For accurate evaluation of the rupture risk using computational fluid dynamic simulation, it is important to analyze more than two models of aneurysm during a follow-up period and focus on significant changes in the values of hemodynamic parameters. [ABSTRACT FROM AUTHOR]

The knowledge of the microanatomy of brain stem perforating arteries can aid in the correct identification of ischemic stroke lesions, explain and provide a proper anatomic description of syndromes associated with the brain stem lesions. The importance of such detailed knowledge is growing when considering the possibilities of acute reperfusion therapy and growing incidence of active treatment of ischemic strokes in posterior circulation. Of course, such knowledge is also vital for neurosurgeons operating in this area. The aim of this work is to present the current knowledge on the anatomy of arteries of the brain stem, brain stem syndromes and present the possibilities of imaging and reperfusion therapy in the vertebrobasilar territory. The Editorial Board declares that the manu-script met the ICMJE "uniform requirements" for biomedical papers. [ABSTRACT FROM AUTHOR]

Aim: Sacroiliac joint (SIJ) dysfunction is a chronic disorder, representing a significant cause of lower back pain. This study aims to present an evidence-based systematic analysis of published literature concerning the surgical management of SIJ dysfunction within the last 10 years. Its main goal is to demonstrate the clinical efficacy of SIJ arthrodesis via preoperative and postoperative analysis of patient pain and disability scores, as well as presenting the incidence of surgery-related complications. Methods: The PRISMA algorithm was used to stratify online search results into 27 studies, which made up our dataset. The parameters collected included study design, number of follow-up patients, surgical complications and preoperative and postoperative Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. A random effects meta-analysis model was used to analyze the selected data, statistical heterogeneity was assessed using the inconsistency I test, publication bias was analyzed using the funnel plot and Egger's test. Results: The mean (95% CI) values of the preoperative VAS and ODI scores were 7.86 (7.65–8.07) and 55.1 (49.8–60.5), resp. These values improved postoperatively to a mean (95% CI) score of 3.23 (2.89–3.58) for VAS and 30.7 (25.9–35.5) for ODI. The total number of recorded surgical complications was 7.04%. The mean (95% CI) incidence of wound complications was 3.87% (2.44–6.09) and the mean (95% CI) proportion of screw dislocation or malposition was 4.32% (3.18–5.81). The proportion (95% CI) of patients requiring a second operation was 5.19% (3.93–6.83). Conclusion: This study demonstrated that patients indicated for sacroiliac stabilization showed significant improvement in VAS (by 4.6 points) and ODI (by 25 points) scores. These findings suggest that SIJ stabilization is a feasible and effective treatment option for this group of patients. Furthermore, overall morbidity of the procedure was lower than in previously reported studies and is expected to decrease with improvement in surgical technique and navigational imaging. [ABSTRACT FROM AUTHOR]

Aim: Retrospective evaluation of a consecutive cohort of adult intrinsic brain tumor patients operated in Ústí nad Labem (Czech Republic) from 2015 to 2017 focusing on the assessment of postoperative morbidity. Patients and Methods: Basic evaluated variables included neurological morbidity, subgaleal cerebrospinal fluid collection or duration of hospitalization. In the subgroup of patients with high-grade gliomas, the parameters of the organization of subsequent oncological care, such as the waiting time until the start of radiotherapy were evaluated, together with overall survival estimations. Results: A total of 270 surgeries were performed (average age 60 years, 59% men). Newly dia-gnosed glioblastomas (GBM) represented 37.4% of the surgeries, while metastases were 32.6% of the total. Severe neurological morbidity was observed in 18 patients (6.7%). Subgaleal cerebrospinal fluid collection was dia-gnosed in 13% of patients. The average length of hospitalization was 6.6 days. About 30% of patients underwent complete oncological treatment. The median waiting time for radiotherapy was 46 days after surgery (no effect on overall survival). The median overall survival of patients with GBM was 8.8 months (95% CI 2.2–13.4). Significantly longer overall survival was observed in patients who were able to undergo treatment according to the Stupp regimen (22.6 vs. 4.3 months, P < 0.001), those after resection vs. bio-psy (12.4 vs. 4 months, P < 0.001) and younger patients ≤ 60 years (19.4 vs. 5.1 months, P < 0.001). Conclusion: We observed overall low postoperative morbidity in our cohort of neurooncology patients. Self-evaluation of results is an integral part of complex neurosurgical care. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers. [ABSTRACT FROM AUTHOR]

This paper is a retrospective analysis of a 33 patient cohort with dia gnosis of glioblastoma multiforme treated us ing gam ma knife stereotactic radiation ther apy fol low ing surgical resection and fractionated radiation ther apy. Over al l, 35 stereotactic radiation procedures were performed. Within this group, we differentiated patients who benefited from these procedures - we managed to stabilise or achieve remis sion of the dis ease in 13 cases (37%) in a 3 month fol low-up and in 6 cases (18%) in a 6-month fol low-up. Long-term remis sion of this highly malignant tumor us ing gamma knife ther apy was achieved in 4 patients. [ABSTRACT FROM AUTHOR]

Computational fluid dynamics have developed in the area of cerebrovascular dis eases in recent years, especial ly in the research of intracranial aneurysms. The goal of most studies is to understand the pathophysiology of the initiation, growth and rupture of brain aneurysms and determine those risk hemodynamic parameters that lead to such proces ses. In our paper, we sum marize the cur rent state of art computational fluid dynamics especial ly from a surgical point of view of intracranial aneurysms and we focus on its pos sible contribution in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The influence of antiplatelet agents and anticoagulants on hemorrhagic complications and the development of ischaemic brain lesions during carotid endarterectomies (CEAs) was studied. Methods: During 559 CEAs antithrombotic therapy, as administrated by a referral doctor, was kept. The influence of antithrombotic therapy on the: 1. incidence of wound hematoma; 2. incidence of symptomatic intracerebral hematoma after CEA; 3. length of hospital stay; 4. incidence of new brain ischaemic lesions were studied. Results: In total, wound hematoma was found in 43 (7.69%) cases. Of those there were: 1. 2.94% in „no antithrombotic” group; 2. 5.18% (p = 0.55) in the acetylsalicylic acid (ASA)/ASA + derivates group; 3. 18.36% (p = 0.008) in clopidogrel group; 4. 0% in ticlopidin group; 5. 20% = 0.022) in low molecular weight heparin (LMWH) group; 6. 19.05% (p = 0.026) in LMWH + ASA group; 7. 36,36% (p = 0.003) in clopidogrel + ASA group. Incidence of symptomatic intracerebral hematoma after CEA was 0.89% in five cases. The mean length of hospital stay was 4.7 days for uncomplicated cases, 5.1 days for cases with hematoma without reoperation and 7.2 days for cases with hematoma with reoperation. Incidence of new ischaemic lesions after CEA was 10.91%, not related to antithrombotic therapy (p > 0.18). Conclusion: Clopidogrel, LMWH and LMWH + ASA groups showed app. 4 times higher risk of wound hematoma, dual antiplatelet therapy 5.5 times higher compared to ASA therapy only. Therefore, their use preoperatively in CEA should be restricted for cases of symptomatic stenosis with high recurrent risk of stroke. No influence of antithrombotics on the incidence of new ischaemic brain lesions dur i ng CEA was showed. Práca [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a disease with many unanswered questions. General effort is to find a simple and non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is a topic for intensive research. Diffusion tensor imaging (DTI) is one of the MRI modalities. This examination can detect microstructural changes of the cerebral white matter. The aim of this study was to compare the DTI parameters in iNPH patients before and after a surgery and with healthy volunteers. Material and methods: MRI was performed in patients before surgery and 1 year after. We also examined age-matched healthy volunteers. The DTI parameters (fractional anisotropy; FA and mean diffusivity; MD) were measured in the anterior and posterior limb of the internal capsule and in the corpus callosum (ALIC, PLIC, CC). Acquired data were statistically analysed. We enrolled 27 patients with iNPH and 24 healthy volunteers. Results: MD was higher in all measured regions comparing iNPH and healthy volunteers (p < 0.05). FA was higher in the PLIC only (p < 0.001). Comparing our data before surgery and one year after, we found significant decrease of FA in the PLIC (p < 0.001) but FA in this region did not reached the FA level in the healthy volunteers group (0.63 after the surgery vs. 0.58 in volunteers). No other significant change in FA or MD was noticed. Conclusion: This study proved, that the FA in the PLIC is significantly higher in iNPH patients than in healthy volunteers. After the surgery, FA decreased. MD values were significantly higher in iNPH patients in the ALIC, PLIC and CC with no decrease after the surgery. It reflects degeneration of the white matter in iNPH patients. [ABSTRACT FROM AUTHOR]

Background: Lateral or supine positions are the traditional positions for cranial tumor resections performed with an “awake” component. These positions are used effectively for patients with tumors adjacent to speech centers or located in the superior frontal or precentral gyrus respectively. However, these may be unsatisfactory for tumors in a close proximity to the parieto-occipital region. In this case report, we describe “awake” surgery performed on a patient in semisitting position. Case description: A 57-year-old patient suffered second recurrence of a glioblastoma multiforme tumor with subcortical invasion of the postcentral gyrus. Due to a high risk of severe neurological deficit, it was decided to perform an awake surgery with the semisitting position providing the best exposure to the lesion and the pyramidal tract. The pyramidal tract of the patient was mapped using motor responses to regular stimuli during which the surgeon recected the tumor. The patient was fully cooperative throughout the procedure and subjectively described the semisitting position as comfortable. Postoperatively, the patient showed no signs of new neurological deficits. Planned re-radiation therapy was not performed. Conclusion: This clinical case demonstrates successful use of the semisitting position in “awake” surgery and we recommend considering its use for tumors in previously challenging locations, such as the lower parietal lobules or postcentral gyrus. This position could also be used during surgeries involving visual pathways mapping. [ABSTRACT FROM AUTHOR]

Background: Disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings on MRI were described as a prognostic factor for responsiveness to the treatment of idiopathic normal pressure hydrocephalus (iNPH). Our premise is that DESH could be associated with compression of the cerebral white matter. Microstructural changes can be identified using diffusion tensor imaging (DTI), specifically fractional anisotropy (FA). The aim of this study is to compare FA in iNPH patients with and without DESH and healthy controls. Methods: We analysed 1.5-T MRI scans of patients fulfilling the criteria of probable or possible iNPH and positive supplementary tests before and after surgery (ventriculo-peritoneal shunt). FA was measured in the anterior and posterior limb of the internal capsule (PLIC) and in the corpus callosum. Patients were divided into the DESH and non-DESH group. These data were also compared to FA values in the control group. Results: Twenty-seven patients and 24 healthy controls were enrolled. DESH was present in 15 patients and lacking in 12. Twenty-three iNPH patients were shunt responders (85.2 %), and 4 were non-responders (14.8 %). All patients in the DESH group were shunt responders. In the non-DESH group, eight patients were responders (66.7 %). A significant difference between the DESH and non-DESH group was found in the FA of the PLIC. The mean value of FA in the PLIC was 0.72 in the DESH group and 0.66 in the non-DESH group. After the surgery FA decreased in both groups. In the DESH iNPH group FA PLIC decreased to 0.65 and in the non-DESH iNPH group to 0.60. In the healthy controls, the mean FA in the PLIC was 0.58. Conclusion: DESH on MRI scans is related to a higher FA in the PLIC with a decrease after the surgery. It reflects a more severe compression of the white matter than in non-DESH patients or healthy volunteers. DESH patients had better outcome than non-DESH patients. This study confirmed the importance of DESH as a supportive sign for iNPH. [ABSTRACT FROM AUTHOR]

Background: Arachnoid cysts (ACs) are congenital benign collections of cerebrospinal fluid (CSF) making up to 1% of intracranial lesions and with an estimated at 2,6% in the pediatric population. Conservative and surgical treatment is available for these lesions, yet no specific treatment algorithm is widely accepted. Treatment of choice various based on clinical symptoms, cyst size and location and associated complications such as subdural or intracystic hemorrhage. There is general consensus is that symptomatic ACs are indicated for surgical treatment. Case Description: The following case report depicts the case of a 15-year-old boy with a large Galassi Type III arachnoid cyst, which was firstly asymptomatic and later presented with transient focal neurological deficits following rupture. A conservative approach was used throughout the case and resulted in spontaneous resolution of the cyst. A short literature review of conservatively treated symptomatic ACs is presented. Conclusion: This case report demonstrates that a conservative approach of arachnoid cyst treatment may be successful in specific cases of large, symptomatic Galassi III arachnoid cysts, thus avoiding potential surgical risk. Although we believe that a surgical approach is warranted in the majority of cases with symptomatic ACs, a conservative approach should be considered in ACs with mild, transient or vague clinical symptoms and stable diagnostic imaging. [ABSTRACT FROM AUTHOR]

Aim: Anterior choroidal artery aneurysms (AChoAA) belong to less frequent cerebrovascular lesions and therefore there are still only a few reports describing their neurosurgical management. We decided to share our experience and present two unusual cases of AChoAA we have treated in our department. We also report one of the first published use of the Yasargil T-bar fenestrated clip for solving of a AChoAA. Methods: We present two cases of unruptured AChoAA treated in 2016 with respect to patient's history, radiological and microsurgical anatomy of the aneurysm, surgical procedure and clinical follow-up. Results: Both aneurysms were successfully treated with surgical clipping. In case 1 we used a single T-bar fenestrated clip. To our best knowledge this might be the first reported use of such clip in treatment of AChoAA. In case 2 for a large AChoAA a standard straight Aesculap clip was used. Both procedures were performed with microvascular Doppler sonography and under electrophysiological monitoring with motor-evoked potentials (MEP). Temporary disturbance in MEP signal during surgery was observed in the T-bar clip case and led to reposition of the clip. Both patients had a good surgical outcome without any clinical or radiological signs of ischemia in the AChoA or any other territory. Conclusion: As previous literature we confirm that surgical treatment of AChoAA is a good and safe alternative to endovascular treatment. We propose, using T-bar fenestrated clip might be appropriate solution for treatment of these lesions. We also suggest that combination of monitoring methods (MVDS, ICG and MEP monitoring) during AChoAA surgery is a very valuable way for prevention of ischemic infarction in the AChoA territory. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article Cerebrospinal fluid lactate: measurement of an adult reference interval, published in a previous issue is presented.