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Atypical intracranial vascular malformations: their behavior, treatment and follow-up
Voldřich, Richard ; Netuka, David (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
Therapy and follow-up of patients with atypical vascular malformations are not standardized. The goals of this dissertation are the comparison of relevant treatment and imaging methods, the determination of an optimal follow-up program based on the type of lesion or the character of therapy, and the documentation of the behavior of atypical malformations after incomplete closure. Long-term observation of 195 embolized dural arteriovenous malformations (DAVM) confirmed the high success rate of Onyx embolic material compared to other agents - complete occlusion was achieved in 88% of cases compared to 35% in the control group. A total of 93% of DAVMs treated with Onyx were closed at the last follow-up. The material also proved to be stable in the long term. Recurrence was diagnosed in 1,8% of patients. The recurrences of DAVM occur due to the accentuation of originally negligible vascular fistulas that are not visible on post-interventional digital subtraction angiography (DSA). Prospective comparison of magnetic resonance angiography (MRA) and DSA concluded that patients after complete embolization of dural fistula can be safely followed using only MRA. In the case of carotid-cavernous fistulas (CCFs), imaging and clinical outcomes of traditional and new endovascular materials, as well as...
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Prognostic significance of levels of brain specific biochemical markers in head injury patients
Homolková, Helena ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Netuka, David (referee) ; Brichtová, Eva (referee)
OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...
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Pineal lesions: clinical presentation, hormone secretion, sleep quality and effect of surgical treatment
Májovský, Martin ; Netuka, David (advisor) ; Šonka, Karel (referee) ; Lipina, Radim (referee)
Introduction: Pineal region is a deep-seated part of the brain surrounded by highly eloquent structures. Differential diagnosis of space-occupying lesions in this region encompasses pineal gland cysts, pineal gland tumours, metastases, germ cell tumours, meningiomas, gliomas, hemangioblastomas and neuroectodermal tumours. In this thesis, I focused mainly on patients with pineal cysts, which is a benign affection of the human pineal gland on the borderline between pathology and normality. The clinical management of patients with a pineal cyst remains controversial, especially when patients present with non-specific symptoms. A melatonin secretion in patients with a pineal cyst before and after a pineal cyst resection has not been studied yet and the effect of surgery on human metabolism is unknown. Materials and Methods: We performed a prospective study between 2000 and 2016. All patients with a pineal cyst larger than 7 mm were included. Epidemiological data, presenting symptoms, surgical results and radiographic and clinical follow-up were documented. We examined melatonin, cortisol and blood glucose secretion profiles perioperatively in a subgroup of 4 patients. The control group was represented by 3 asymptomatic patients with a pineal cyst. For each patient, 24-h circadian secretion curves of...
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A practical value of different intraoperative electrophysiological methods in pediatric epilepsy surgery patients
Leško, Róbert ; Kršek, Pavel (advisor) ; Netuka, David (referee) ; Doležalová, Irena (referee)
Epilepsy, as the most common chronic neurological disease, affects a significant part of population (0.5-1%). Drug resistant epilepsy has a significant negative effect on the quality of life, psychiatric comorbidities, neurocognitive performance and the risk of SUDEP in children. Therefore, resective epilepsy surgery, the only curative treatment of this condition, can fundamentally reverse this unfavorable prognosis. An inevitable prerequisite for a good postoperative result is complete removal of the epileptogenic zone (EC) and preservation of eloquent areas (EC). At present, even with improving and new preoperative non-invasive methods, we don't have an exclusive diagnostic method for theirs delineation. The aim of this PhD study is to assess benefit of individual intraoperative electrophysiological (iEF) methods in pediatric patients with focal intractable epilepsy. The first study evaluates the importance of intraoperative electrocorticography (iECoG) in the localization of EZ. The study proved that iECoG serves as a reliable tool to guide surgical resection and may predict results of epilepsy surgery. iECoG-based modification of surgical plan is not associated with increased risk of significant complications. The second presented study analyzed the contribution of intraoperative electrical...
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Pineal lesions: clinical presentation, hormone secretion, sleep quality and effect of surgical treatment
Májovský, Martin ; Netuka, David (advisor) ; Šonka, Karel (referee) ; Lipina, Radim (referee)
Introduction: Pineal region is a deep-seated part of the brain surrounded by highly eloquent structures. Differential diagnosis of space-occupying lesions in this region encompasses pineal gland cysts, pineal gland tumours, metastases, germ cell tumours, meningiomas, gliomas, hemangioblastomas and neuroectodermal tumours. In this thesis, I focused mainly on patients with pineal cysts, which is a benign affection of the human pineal gland on the borderline between pathology and normality. The clinical management of patients with a pineal cyst remains controversial, especially when patients present with non-specific symptoms. A melatonin secretion in patients with a pineal cyst before and after a pineal cyst resection has not been studied yet and the effect of surgery on human metabolism is unknown. Materials and Methods: We performed a prospective study between 2000 and 2016. All patients with a pineal cyst larger than 7 mm were included. Epidemiological data, presenting symptoms, surgical results and radiographic and clinical follow-up were documented. We examined melatonin, cortisol and blood glucose secretion profiles perioperatively in a subgroup of 4 patients. The control group was represented by 3 asymptomatic patients with a pineal cyst. For each patient, 24-h circadian secretion curves of...
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Prognostic significance of levels of brain specific biochemical markers in head injury patients
Homolková, Helena ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Netuka, David (referee) ; Brichtová, Eva (referee)
OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...
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