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Multimodal monitoring in severe brain damage different etiology regarding to optimal patients therapy and outcome
Habalová, Jiřina ; Náhlovský, Jiří (advisor) ; Galanda, Miroslav (referee) ; Smrčka, Martin (referee)
Multimodal monitoring in severe brain damage of different etiology regarding optimal pacients therapy and outcome. Objectives: The common aim during treatment of patients with brain damage is to maintain adequate cerebral oxygenation. It is necessary to monitor vulnerable areas of the brain in terms of oxygen content. This paper summarizes the theoretical and practical aspects of noninvasive continuous monitoring of regional cerebral oxygenation (rSO2) with near - infrared light of specific wavelength (infrared spectroscopy) by means of the device INVOS (In Vivo Optical Spectroscopy) in neurosurgical patients. Methods: The authors present the results of monitoring rSO2 in four groups of patients with brain damage of different etiology (n=10). Patients after spontaneous intracerebral hemorrhage (Group 1, n1=10) were followed by rSO2 before and after treatment of reactive hypertension. In patients with vazospazm after subarachnoid hemorrhage of ruptured aneurysm (Group 2, n2=16) were measured and investigated the value of rSO2, which was resulted in remission of symptoms. In patients prior to cerebral vascular anastomosis (Group 3, n3=18) was followed rSO2 during stress test and the results were compared with SPECT examination. In patients with traumatic brain injury (Group 4, n4=30) were measured...
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The impact of neuoropretection on brain metabolism and cognitive function during carotid endarterectomy
Mraček, Jan ; Choc, Milan (advisor) ; Chytra, Ivan (referee) ; Náhlovský, Jiří (referee)
The impact of neuroprotection on brain metabolism and cognitive function during carotid endarterectomy Introduction: Neuroprotection is a strategy that works against the biochemical and molecular manifestations that lead to ischemic brain injury. The aim of neuroprotection is to protect the hypoperfused brain region through influence upon ischemic cascade and by reducing the progress of injurious reperfusion. The development of neuroprotection has been proceeding alongside a growing understanding of brain ischemia pathophysiology. In spite of the demonstrable effects of many agents in animal models, until now none of the tested neuroprotective agents have been shown to improve the outcome in a phase III clinical trial. Objectives: Primary objective of this study was to evaluate the impact of neuroprotection, administered before carotid endarterectomy, on brain metabolism and cognitive function. The potential influence of metabolic changes within the brain on clinical outcome was assessed. The secondary objective was to assess the satisfaction of patients with the type of anesthesia administered (general or local) and to consider the preference for general or local anesthesia during similar operations in the future. Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combine...
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The significance of the S100B protein in patients with an injury to the central nervous system
Lavička, Pavel ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Novák, Zdeněk (referee) ; Sameš, Martin (referee)
Inroduction: The S100B protein is a small dimeric protein which belongs to a group of calcium binding proteins. It is found in astroglial cells in the central nervous system (CNS). The S100B protein is detected, at very low concentrations, in fat tissue, muscle and bone marrow. We can measure this marker in the cerebrospinal fluid, in serum and in urine. The commercially available assay measures the sum of two different dimers (the S100A1B and S100BB) which collectively are called the S100B protein.The level of this marker increases significantly in patiens with CNS damage. Studies of patients with isolated head trauma have demostrated a correlation between serum marker level, neurological findings and outcome. In patients with polytrauma there is a problem to evaluating the initial S100B protein level with regards to CNS damage, because the S100B protein level can be affected by extracerebral sources of the S100B protein. Aim of study: The aim of our study was to evaluate the significance of the S100B protein in patiens with either isolated head trauma or polytrauma and to evaluate the significance of the initial level and the significance of dynamic monitoring of the S100B protein levels. The importace of these levels for predicting primary CNS damage, and for making a prognosis of such patiens...
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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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Endoscopic treatment for posthemorrhagic hydrocefalus in premature newborns
Lipina, Radim ; Náhlovský, Jiří (advisor) ; Smrčka, Martin (referee) ; Smrek, Martin (referee)
Endoscopic treatment for posthemorrhagic hydrocefalus in premature newborns Abstract Introduction: Up to date the pathophysiology of posthemorrhagic hydrocephalus (PHH) in premature newborns is explained as a consequence of cytokine TGF β1 release into cerebrospinal fluid (CSF) during initial bleeding, followed by induction of "inflamatory proteins" in subarachnoideal spaces. Method of choice in treatment of PHH is ventriculo-peritoneal drainage. The role of endoscopic third ventriculostomy (ETV) in these patients is unclear, through obstruction is proved in some patients with PHH. The aim of our study was to monitor the success rate of ETV in the group of premature newborns with obstructive PHH and to ascertain the relation between TGF β1 levels and developement of hyporesorptive hydrocefalus and thus ETV succes rate, which has not been reported yet. Materials and methods: We followed 38 premature newborns with PHH since January 2004 to November 2007. 34 patients was treated by Ommaya reservoir implantation and repeated taps. In 29 patients TGF β 1 level was examinated. In case of persisting hydrocephalus MRI of brain was performed. In 25 patients with proved obstruction on MRI ETV was indicated. We evaluated ETV succes rate and those relation to TGF β 1 CSF levels. Results: In 73,5% patiens in our series...
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Decompressive craniotomy in craniocerebral injury - evaluation of outcome one year after trauma
Navrátil, Luděk ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Haninec, Pavel (referee)
The study presents analysis of group of 110 patients treated for craniocerebral trauma by means of decompressive craniotomy between January 1999 and December 2003. The influence of different factors to the outcome of patient one year after injury was evaluated. Among the factors in view we included age, clinical status and its worsenig after admission, accompanying injuries, time period between injury and operation, finding during operation, intracranial pressure and postoparative complications. In addition to evaluation of particular factors to the outcome of patients we followed the correlation between various factors. Results: perimesencephalic cisterns and thickness of subdural hematoma were evaluated. In the subgroup of patients with subdural hematoma (n=63) it was found, that worsening of the outcome correlated with the thickness of subdural hematoma (p = 0.,025) and with the shift in the CT (p = 0.0001). Correlation between shift or width of cinsterns to the outcome of all patinets (n = 110) was not found. The perioperative measurement of dural gap before the duroplasty is the speciality of this work. In all patients (n = 110) the correlation between dural gap and the outcome was not found. In older patients the dural gap was lesser (p = 0.021). But in older patients the subdural hematoma was...
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The analysis of the risk factors in gamma knife radiosurgery for benign meningiomas
Kollová, Aurélia ; Liščák, Roman (advisor) ; Zvěřina, Eduard (referee) ; Náhlovský, Jiří (referee)
DOCTORAL THESIS ABSTRACT THE ANALYSIS OF THE RISK FACTORS IN GAMMA KNIFE RADIOSURGERY FOR BENIGN MENINGIOMAS MUDr. Aurélia Kollová, MBA Consultant: Assoc. Prof. MUDr. Roman Liščák, Ph.D. Doctoral thesis represents results of the analysis of Gamma Knife radiosurgical treatment of meningiomas, benign intracranial tumors, and the risk factors related to the treatment in 368 patients with 400 meningiomas treated at the Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital in Prague between 1992 and 1999. Detailed analysis of the results of skull base meningiomas was performed, as well as analysis of long-term results. Edema prediction model was created in order to identify patients with higher risk for post treatment complications with its practical clinical implication. The actuarial tumor 5- and 10- years control was 97,9% and 94,7% respectively, what confirms efficiency of radiosurgical treatment, with low temporary and permanent morbidity of 9,6% and 1,3% respectively, which was rarely disabling. Radiosurgery as a minimally invasive technique is a treatment of choice of meningiomas in skull base fulfilling size criteria; as a part of multimodal approach in large meningiomas, in patients, who would not tolerate operative procedure and in elderly. Dissertation thesis consists of six...
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The analysis of the risk factors in Gamma knife radiosurgery for benign meningiomas
Kollová, Aurélia ; Liščák, Roman (advisor) ; Náhlovský, Jiří (referee) ; Zvěřina, Eduard (referee)
Doctoral thesis represents results of analysis of stereotactic radiosurgical treatment of meningiomas, benign intracranial tumors, and the risk factors related to the treatment in 368 patients with 400 meningiomas treated at the Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital in Prague between 1992 and 1999. Detailed analysis of the results of skull base meningiomas was performed, as well as analysis of long-term results. An edema prediction model was created in order to identify patients with higher risk for post treatment complications with its practical clinical implication. The actuarial tumor 5 and 10 years control was 97,9% and 94,7% respectively, what confirmes efficiency of radiosurgical treatment, with low permanent morbidity of 6,4% and zero mortality. Radiosurgery as a minimally invasive technique is a treatment of choice of meningiomas in skull base filfilling size criteria; as a part of multimodal approach in large meningiomas, which cannot be excised completely, in patients, who would not tolerate operative procedure and in elderly. Doctoral thesis consists of seven chapters and 4 appendices.The first chapter deals with theoretical background of meningioma as a nosologic entity. Hypotheses and goals of the study are defined in the second chapter. The third chapter...
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Multimodal monitoring in severe brain damage different etiology regarding to optimal patients therapy and outcome
Habalová, Jiřina ; Náhlovský, Jiří (advisor) ; Galanda, Miroslav (referee) ; Smrčka, Martin (referee)
Multimodal monitoring in severe brain damage of different etiology regarding optimal pacients therapy and outcome. Objectives: The common aim during treatment of patients with brain damage is to maintain adequate cerebral oxygenation. It is necessary to monitor vulnerable areas of the brain in terms of oxygen content. This paper summarizes the theoretical and practical aspects of noninvasive continuous monitoring of regional cerebral oxygenation (rSO2) with near - infrared light of specific wavelength (infrared spectroscopy) by means of the device INVOS (In Vivo Optical Spectroscopy) in neurosurgical patients. Methods: The authors present the results of monitoring rSO2 in four groups of patients with brain damage of different etiology (n=10). Patients after spontaneous intracerebral hemorrhage (Group 1, n1=10) were followed by rSO2 before and after treatment of reactive hypertension. In patients with vazospazm after subarachnoid hemorrhage of ruptured aneurysm (Group 2, n2=16) were measured and investigated the value of rSO2, which was resulted in remission of symptoms. In patients prior to cerebral vascular anastomosis (Group 3, n3=18) was followed rSO2 during stress test and the results were compared with SPECT examination. In patients with traumatic brain injury (Group 4, n4=30) were measured...
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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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