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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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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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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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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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Intracranial Aneurysms - Treatment Options and Natural Course. Safety and Efficacy of Treatment Strategies for Posterior Inferior Cerebellar Artery Aneurysms.
Petr, Ondřej ; Beneš, Vladimír (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer neurological outcomes compared to other intracranial aneurysms. At first, as part A, we conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA-aneurysms. Subsequently, as part B, we performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with contemporary microsurgical and endovascular techniques. METHODS: For the meta-analysis, a systematic search of Medline, EMBASE, Scopus and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA-aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN-palsies rates, and long-term neurological morbidity/mortality. As the second part, aiming to report the current trends and results in treatment strategies for PICA-aneurysms, records of 94 patients treated for PICA-aneurysms between 2000 and 2015 at 3 large referral neurovascular centers were retrospectively reviewed. RESULTS: In the meta-analysis, we...
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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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Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.
Radovnický, Tomáš ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Bartoš, Aleš (referee)
8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients...
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Weight changes in patients with Parkinson's disease treated with Deep Brain Stimulation.
Undus, Lucie ; Růžička, Evžen (advisor) ; Baláž, Marek (referee) ; Haninec, Pavel (referee)
1 Abstract Body weight changes have been described in the course of Parkinson's disease (PD) as well as following bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) performed in advanced PD. According to the literature weight changes occur in 50-100% of patients who undergo STN DBS. In the last 15 years extensive efforts have been put in understanding the underlying mechanisms behind the weight changes following STN DBS in advanced PD patients however many sources still report conflicting evidence. Improved motor status, reduction in dyskinesias, decrease in energy expenditure, dopaminergic medication reduction, modification of food intake, hormonal factors, regional effects of stimulation were all speculated to cause this weight gain. We hypothesized that patients who underwent STN DBS procedure in our center would gain weight as reported in the literature (study 1, study 2). The etiology of post STN DBS weight gain has not been fully elucidated up to date, in our second study we further hypothesized that the weight changes are due to dysregulation of food related hormones and parameters (study 2). In the third study we hypothesized that weight gain is associated with position of active electrode contact (study 3). Aims of the study: The primary aims of our studies were to assess body...
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Index listovej plochy a priestorová distribúcia asimilačného aparátu v poraste buku lesného (Fagus sylvatica L.)
Haninec, Pavel
One of the most important parameters determining penetration of the photosynthetically active radiation (FAR) through the forest canopy is the leaf area index (LAI). In this thesis we concerned with a comparison of direct and indirect approaches of determining LAI and the vertical distribution of LAI in the canopy. There have been used three optical methods, using the device LiCor LAI 2200 Plant Canopy Analyzer, LaiPen and hemispherical photography. Also, we used the method of estimation LAI using airborne laser scanning. There was created allometric relationship between leaf area and the perimeter of the sample trees. These trees were also destructively processed and based on those, there were created the diagrams of the vertical distribution of leaves in the crowns of these trees. The individual values of the measured leaf area index, were in amplitude from 3.69 m2.m-2 to 11.80 m2.m-2 and the indirect methods underestimated the direct approach in average of 28.46%.
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Obstetric brachial plexus palsy
Mencl, Libor ; Haninec, Pavel (advisor) ; Rokyta, Richard (referee) ; Ehler, Edvard (referee)
Obstetrical brachial plexus palsy (OBPP) displays a stable incidence of 0.15 - 3 per 1,000 live births. Most children show good spontaneous recovery, but a recent literature reviews show that a residual deficit remains in 20% to 30% of children. Shoulder dystocia, macrosomia and instrument delivery, forceps or vacuum extraction present the greatest risk for brachial plexus injury. Caesarean section, having a twin or multiple birth mates seems to offer some protection against injury. The resulting nerve injury may vary from neurapraxia or axonotmesis to neurotmesis and root avulsion from spinal cord. In neurapraxia or axonotmetic lesions complete recovery will usually occur over the course of weeks or months. In a neurotmetic injury or in case of root avulsion, the most sever type of lesion, useful regeneration of axons cannot take place. Although we perform electromyography and imaging studies, the final decision of operation relies heavily on the clinical examination. Manual muscle testing system although reliable for examination of motor power in adults is not suited for use with infants. All patients involved in the study were evaluated using the Active Movement Scale (AMS), which greatly increases the ability to detect partial movements. The results of neurophysiological investigations in older...
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