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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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Nanotechnology and biomaterials for application in cell therapy of spinal cord injury
Vaněček, Václav ; Haninec, Pavel (referee) ; Smetana, Karel (referee)
New approaches for the treatment of SCI use advances in the fields of nanotechnology, biomaterial science and cell therapy. The results presented in this thesis showed that superparamagnetic iron oxide nanoparticles coated with a stable dopamine-hyaluronane associate can be used for the safe and effective labeling of MSC. Cell labeling efficiency, viability and the relaxivity of the tested particles were significantly better than those obtained with the commercial particles Endorem®. The DPA-HA coated nanoparticles can be used for the noninvasive monitoring of cell therapy using MRI. Furthermore, we showed that SPION can be used for the targeted delivery of MSC to the site of a spinal cord lesion. The labeled cells can be concentrated in the lesion area by means of a magnetic implant. The process of cell targeting depends on the physical characteristics of the magnetic implant as well as on the biological features of the cells and nanoparticles, as we described with a proposed mathematical model. It is possible to modify the properties of the magnetic system, e.g. by changing the shape or size of the magnet, thus tuning the magnetic force distribution and the gradient of the magnetic field necessary for effective cell targeting. A promising therapeutic strategy for the treatment of spinal cord injury is the...
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Nanotechnology and biomaterials for application in cell therapy of spinal cord injury
Vaněček, Václav ; Syková, Eva (advisor) ; Smetana, Karel (referee) ; Haninec, Pavel (referee)
New approaches for the treatment of SCI use advances in the fields of nanotechnology, biomaterial science and cell therapy. The results presented in this thesis showed that superparamagnetic iron oxide nanoparticles coated with a stable dopamine-hyaluronane associate can be used for the safe and effective labeling of MSC. Cell labeling efficiency, viability and the relaxivity of the tested particles were significantly better than those obtained with the commercial particles Endorem®. The DPA-HA coated nanoparticles can be used for the noninvasive monitoring of cell therapy using MRI. Furthermore, we showed that SPION can be used for the targeted delivery of MSC to the site of a spinal cord lesion. The labeled cells can be concentrated in the lesion area by means of a magnetic implant. The process of cell targeting depends on the physical characteristics of the magnetic implant as well as on the biological features of the cells and nanoparticles, as we described with a proposed mathematical model. It is possible to modify the properties of the magnetic system, e.g. by changing the shape or size of the magnet, thus tuning the magnetic force distribution and the gradient of the magnetic field necessary for effective cell targeting. A promising therapeutic strategy for the treatment of spinal cord injury is the...
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The Carotid Stump Syndrome
Hrbáč, Tomáš ; Beneš, Vladimír (advisor) ; Přibáň, Vladimír (referee) ; Haninec, Pavel (referee)
Introduction: Internal Carotid Stump Syndrome may be one of the possible causes of ischemic stroke (iCMP), as well as retinal infarction (RI). Syndrome of the occluded internal carotid (ACI) (stump syndrome) is a nosological unit, which is characterized by an onset of ipsilateral iCMP or RI of thromboembolic ethiology in patients with occlusion of ACI via the externa carotid or arteria ophthalmica. In my thesis, I have concentrated upon the specification of the stump syndrome, its diagnostics and treatment; furthermore I have assessed the appropriateness of surgical approach in comparison with conservative approach. Material and methods: A total of 621 patients with occlusion were treated in two centres in the course of five years. In a group of 40 patients, the ACI occlusion was detected sonographically, the length of the occluded ACI being >5 mm, with normal vasoreactivity based upon SPECT CO2 and excluded cardiogenic cause of iCMP. The patients were divided in two groups - surgical and conservative. Patients were monitored in 6-month intervals for the total period of four years. Results: No RI or iCMP were detected in the surgical group; one patient died six months after surgery. We observed one case of amaurosis fugax in the conservative group. Conclusion: Ultrasound examination is a fully sufficient...
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The determination of the end-to-side anastomosis within the neurotization techni ques in thebrachial plexus reconstruction and the influence of the locally appli ed VEGF on the peripheral nerve regeneration
Kaiser, Radek ; Haninec, Pavel (advisor) ; Zvěřina, Eduard (referee) ; Ehler, Edvard (referee)
There is rising importance of the brachial plexus injury firstly due to its increasing incidence as a result of higher survival rate of the patients after polytrauma and due to the higher success rate of the surgical treatment. Recently, the obstetric brachial plexus palsy is the area of interest of many articles. The indication criterion is one of the most important problems to be solved as well as increasing awareness about the possibility of the surgical treatment. Many of injured elements of the brachial plexus are reconstructed by a donor nerve transfered onto the recipient nerve, i.e. by neurotization. This method can have better outcome than the suturing of the proximal parts of the plexus especially due to its main advantage - suturing as close to the muscle as possible. It is still not clear which donor nerve is better to use for neurotization of specific recipients due to the lack of large randomized clinical trials. End-to-side anatomosis (ETS) was re-discovered at the beginning of 90's at the same time when the Oberlin method (OT) was firstly described in the literaure. These techniques are applicable only in the Erb's palsy with functional lower part of the plexus. The basis of the effect of ETS anastomosis is the collateral sprouting of the axons which is one of the most important...
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Unruptured intracranial aneurysms : Does the risk of endovascular treatment outweigh natural history?
Beneš, Vladimír ; Stejskal, Lubor (advisor) ; Haninec, Pavel (referee) ; Janoušková, Ladislava (referee)
Summary: Background: The management of unruptured intracranial aneurysms (UIAs) remains controversial. The international study of UIAs (ISUIA) found low rates of rupture and appreciable treatment risks, which can be interpreted that many UIAs should not be treated. Results of endovascular coiling of 131 patients with UIAs are presented along with a risk-benefit analysis based on patient and aneurysm characteristics. Patients and methods: From December 1996 to September 2005, 131 patients (93 women and 38 men, mean age 51 years) with 151 UIAs were treated using detachable coil embolisation. Data on procedural complications, patient and aneurysm characteristics, clinical and radiological follow-up were entered into a prospectively collected database. A risk-benefit analysis was performed. Results: Endovascular treatment was successful in 145 (96%) aneurysms. One aneurysm ruptured intraoperatively with a fatal outcome. Ten thromboembolic events occurred, leaving one patient moderately disabled. The combined morbidity and mortality rate at 6 months per patient is 1,5% (95% confidence interval: 0,07 - 5,7%). Risk-benefit analysis comparing these data with published natural history suggests that treatment with low complication rates can be offered to most patients with UIAs. Conclusion: UIAs can be coiled with...
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název v anglickém jazyce není uveden
Šámal, Filip ; Haninec, Pavel (advisor) ; Vyklický, Ladislav (referee) ; Zvěřina, Eduard (referee)
Traumatic injury of peripheral nerves represents an important area of present-day clinical and experimental interest. Despite a large quantity of experimental data acquired in an intense research of this topic carried out in recent years, traumatic affection of peripheral nerves continues to be a complex surgical problem. Injury of peripheral nerves often results in a permanent and serious impairment in the patients' lives connected with the loss of the affected peripheral nerve function. If an injured nerve is given a timely and correct treatment, these consequences can be prevented to a certain extent. In the current practice this implies the use of all available methods of peripheral nerves surgery, primarily microsurgical operation technique while observing some of the basic principles essential for a good functional reinervation. This mainly applies to tension-free suture. In some anatomic locations and despite observing the above-mentioned facts, it is still difficult to reach good functional results. This primarily applies to brachial plexus injury which is one of the most complicated and serious of all lesions of peripheral nerves. Out of the total number of nerve injuries they are represented in large sets by three to seven percent. In his set, Midha reports 1.2% of patients affected by the...
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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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Effects of CO2, alcohol, and caffeine on cerebral blood flow and cerebral autoregulation
Bláha, Martin ; Beneš, Vladimír (advisor) ; Haninec, Pavel (referee) ; Kalvach, Pavel (referee)
1. Alcohol intoxication increases cerebral blood flow from 8 to 24 % 2. Alcohol intoxication does not impair dynamic cerebral autoregulation 3. Caffeine (300 mg per oral) decreases cerebral blood flow by 20 % 4. Without CO2 influence, caffeine (300 mg per oral) decreases cerebral blood flow from 10 to 20 %. 5. Caffeine decreases CBF despite severe peripheral cerebrovascular vasodilatation (during hypercapnia caffeine decreases CBF from 11 to 12 %) 6. There is not a statistically significant reduction of CBF during hypocapnia. 7. Vasomotor reactivity testing - Carbon Dioxide challenge test is not affected by pre-test caffeine intake 9. CO2 is a strong regulator of cerebral blood flow (through the regulation of the tone of cerebral vessels) 10. Cerebral vasomotor reactivity in healthy humans is 86.5 ± 19.1, and CO2 reactivity is 3.0 ± 0.6 %/mmHg 11. Cerebral autoregulation is significantly impaired during hypercapnia (autoregulation index decreases from baseline values of 4 ± 0.8 to 0.9 ± 0.9) 12. Increase of etCO2 by 1mmHg decrease ARI by 8.24 % 13. Traumatic brain injuries cause significant impairment of cerebral autoregulation 14. The cyclic leg cuff autoregulation test appears better suited for clinical use than the hyperemic leg cuff step release method. 15. Cerebral autoregulation may respond with...
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