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Evaluation of Reinnervation Changes After Reconstructive Procedures on Peripheral Nerves.Nerve Transfers in Patients with Brachial Plexus Lesions: A Comprehensive Evaluation of Outcomes.
Brušáková, Štěpánka ; Holečková, Irena (advisor) ; Vaverka, Miroslav (referee) ; Ehler, Edvard (referee)
Purpose: The purpose of this study is to analyze the results of brachial plexus reconstructive surgery. The work focused on the analysis of the brachial plexus repair at Masaryk Hospital in Ústí nad Labem between 2012 and 2023. The aim of the study was to focus on a set of patients operated using the technique of nerve transfers. In addition to the clinical results, the presence of neuroplasticity was investigated by monitoring postoperative synkinesis and evaluating factors on which the presence of neuroplasticity depends. Methods: A total of 34 proximal nerve transfers were performed in 21 patients for restoration of shoulder abduction, external rotation and elbow flexion. The evaluation of the results was carried out at least 3 years after surgery. The resulting muscle strength, range of motion, Mallet scale, pain quantification, electrophysiological testing and the presence or absence of synkinesis between donor and recipient were assessed. An evaluation of subjective assessment of the effect of decreased function on normal activities of daily living including work capacity (DASH) was recorded. The results were statistically processed. Results: Of the 34 neurotransfers, 20 achieved M3 or greater strength (58.8 %), and 5 transfers achieved M4 or greater strength. The disappearance of synkinesis...
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Computational Fluid Dynamic Simulation of Intracranial Aneurysms : analysis of time-depend changes of hemodynamic parameters - the road to clinical use
Sejkorová, Alena ; Hejčl, Aleš (advisor) ; Vaverka, Miroslav (referee) ; Přibáň, Vladimír (referee)
Computational Fluid Dynamic Simulation of Intracranial Aneurysms Analysis of time-dependent changes of hemodynamic parameters - the road the clinical use Hemodynamics are involved in the genesis of intracranial aneurysms and time- dependent changes of their parameters lead to aneurysm growth, stabilization or rupture. Definition of these changes using computational fluid hemodynamics could significantly contribute to the understanding of aneurysmal development and rupture and could enable the routine use of mathematical simulations. In this study, computational fluid dynamics were performed for nine incidental aneurysms. Five aneurysms were monitored throughout time and factors leading to aneurysm rupture were analyzed. In four aneurysms the influence of the hemodynamics on the growth was defined. Major growth occurred in areas of low wall shear stress and oscillatory index. These areas increased in size during growth time. Contrary to this, neck shape remodeling occurred in areas with large wall shear stress and pressure. Throughout the follow-up of ruptured aneurysms, the minimal wall shear stress decreased, and the area of low wall shear stress increased significantly. The results indicate that decreasing values of minimal wall shear stress and increasing values of low wall shear stress area...
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The use of MR spectroscopy in neurosurgery
Malucelli, Alberto ; Hájek, Milan (advisor) ; Ryznarová, Zuzana (referee) ; Vaverka, Miroslav (referee)
Proton MR spectroscopy is a non-invasive tool for measuring in vivo concentrations of several metabolites. The aim of this thesis was to test its applicability and reliability in neurosurgical praxis. In the first part of the study multiple MR spectroscopy methods were applied in a group of patients after surgery and oncologic treatment for high-grade glioma to test which method performed best in discriminating recurrent tumor from radionecrosis in the presence of a new enhancing lesion. The best diagnostic yield was achieved by comparison of choline, creatine and lactate between lesion and contralateral side (sensitivity 93.3%, specificity 78.6%). Creatine was significantly decreased in patients compared to controls. The inhibiting effect of ongoing oncologic treatment on cerebral and tumoral metabolism makes differential diagnosis trickier. Therefore, a diagnosis of radionecrosis assessed during ongoing radio- and chemotherapy should be confirmed after its completion. In the second part of the study MR spectroscopy data was compared with MR hippocampal volumetry and transcranial doppler examination in a cohort of patients with unilateral occlusion of the internal carotid artery. The N-acetylaspartate/choline ratio and hippocampal volume were significantly lower in both hemispheres of patients...
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Treatment for Brain Arteriovenous Malformations
Bradáč, Ondřej ; Beneš, Vladimír (advisor) ; Haninec, Pavel (referee) ; Vaverka, Miroslav (referee)
Introduction: The surgical and endovascular results of the treatment of pial AVM provided at our Neurosurgical centre are presented. These results are supported by neuropsychological outcomes of subgroup of treated patients. Going by these results and by an overview of literary data on the efficacy and complications of each therapeutic modality, the optimal algorithm of indications is presented Cohort of patients: The main series comprises 222 patients aged 9 to 87 years treated in the years 1998 - 2013. The surgical group consists of 85 patients, 55 patients received solely endovascular treatment. Thirty-four patients were consulted and referred directly to the Radiosurgical unit. The remaining 48 were recommended to abide by the strategy of "watch and wait". A subgroup of 66 patients, who underwent treatment of AVM was neuro-psychologically tested at least two years after treatment using a battery of tests constructed specifically for this study. A control group consisted of 10 subjects without any neurological disease. Results: In the surgical group, serious complications were 3.5% at a 96.5% therapeutic efficacy. As for AVM treated with purely endovascular methods, serious procedural complications were seen in 5.5% of patients, with efficacy totalling 36.4%. One observed patient suffered...
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Brain Abscess and MR Spectroscopy
Večeřa, Zdeněk ; Kanta, Martin (advisor) ; Vaverka, Miroslav (referee) ; Kolarovszki, Branislav (referee)
Background This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess and to comprehensively evaluate this naturally dreaded complication from a purely medical perspective by using an evidence- based approach and comparison with available literature which mostly comprises case reports. Methods This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012- 2017. Pre-operative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. Particular consideration was given to the effect of pyocefalus on morbidity and mortality rates and C-reactive protein levels, as well as the identification of risk factors and its possible therapeutic influence. Patients were followed up for 6 months. Results MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in...
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Surgical Aspects of Brain Ischaemia Flowmetry in a Clinical Practice and Experiment
Dostál, Jiří ; Přibáň, Vladimír (advisor) ; Vaverka, Miroslav (referee) ; Navrátil, Ondřej (referee)
Dissertation summary Surgical aspects of brain ischemia Flowmetry in a clinical practice and experiment MUDr. Jiří Dostál, Dpt. of Neurosurgery, Charles University, Faculty of Medicine Supervising Tutor: doc. MUDr. Vladimír Přibáň, Ph.D., Dpt. of Neurosurgery, Charles University, Faculty of Medicine The aim of this dissertation is to assess the options and benefits of a transit time flow measurement (TTF) in brain ischemia prevention in neurosurgery. Case reports from the Department of Neurosurgery, Charles University, Faculty of Medicine in Pilsen show the use and the limits of TTF. Presented case reports show the need of an individual approach in the case of a complex brain vessel surgery. A group of patients surgically treated for an unruptured middle cerebral artery aneurysm was analysed. Possible restriction of blood flow after the clip placement was quantitatively assessed by TTF in the first subgroup of patients. No quantitative flow measurement was performed in the second subgroup. There was no statistically significant difference between the two groups in terms of ischemia prevention. Some cases may entitle the surgeon to consider TTF use. TTF measurement is an invasive procedure and it demands a careful approach to the vessel and its preparation. The authors suggest to leave the use of the TTF to...
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Treatment for Brain Arteriovenous Malformations
Bradáč, Ondřej ; Beneš, Vladimír (advisor) ; Haninec, Pavel (referee) ; Vaverka, Miroslav (referee)
Introduction: The surgical and endovascular results of the treatment of pial AVM provided at our Neurosurgical centre are presented. These results are supported by neuropsychological outcomes of subgroup of treated patients. Going by these results and by an overview of literary data on the efficacy and complications of each therapeutic modality, the optimal algorithm of indications is presented Cohort of patients: The main series comprises 222 patients aged 9 to 87 years treated in the years 1998 - 2013. The surgical group consists of 85 patients, 55 patients received solely endovascular treatment. Thirty-four patients were consulted and referred directly to the Radiosurgical unit. The remaining 48 were recommended to abide by the strategy of "watch and wait". A subgroup of 66 patients, who underwent treatment of AVM was neuro-psychologically tested at least two years after treatment using a battery of tests constructed specifically for this study. A control group consisted of 10 subjects without any neurological disease. Results: In the surgical group, serious complications were 3.5% at a 96.5% therapeutic efficacy. As for AVM treated with purely endovascular methods, serious procedural complications were seen in 5.5% of patients, with efficacy totalling 36.4%. One observed patient suffered...
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