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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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Metabolic Changes of the Brain after Subarachnoid Haemorrhage
Adamkov, Jaroslav ; Náhlovský, Jiří (advisor) ; Krahulík, David (referee) ; Smrčka, Martin (referee)
Metabolic changes in the brain after subarachnoid haemorrhage. Summary The goal of the study: The goal of this study is to set concentrations of energetic metabolites in the acute phase (first 24 hours of monitoring) after subarachnoid haemorrhage (SAH) and to define the relation of these concentrations to the clinical and imaging parameters on admi-ssion and final clinical state of the patient one month after the bleeding. Throughout the period of monitoring, in all patients we observed episodes of lactate/pyruvate (L/P) ratio > 30 and their relation to actual readings of intracranial pressure (ICP) and perfuse pressure (CPP). We also monitored concentrations of glycerol in two compartments (brain interstitium and serum). Type of the study: Retrospective clinical study The set and methodology: From 2012 to 2015 we introduced a microdialysis catheter and a sensor for measuring ICP within a multimodal monitoring in 15 patients after subarachnoid bleeding. We performed this multimodal monitoring for a period of 84 days and processed in aggregate 10,080 readings. In 7 patients, together with multimodal monitoring, we also determined the serum concentration of glycerol. The onset of monitoring was always connected with obliteration of the source of bleeding either via surgery or endovascular procedure. Results:...
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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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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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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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Effect of pentoxifyllin on advanced dementia with predominated cardiovascular symptoms
Mészárosová, Jitka ; Ďoubal, Stanislav (advisor) ; Náhlovský, Jiří (referee) ; Mrňa, Boris (referee)
The high consumption of Pentoxifyllin in patients suffering from vascular dementia led to a concern and a clinical trial conducted in the nursing home in Česká Kamenice from 2001 to 2004. The retrospective survey was carried out on 176 patients and lasted 12 months. If we consider the currently valid criteria for the diagnosis of vascular dementia, the patients showed an advanced form of the disease. The experiment did not demonstrate any positive influence of treatment on either cardiovascular diseases or the mortality of afflicted patients. Despite the fact that we could expect the medicament to have a favourable influence on the symptoms of the advanced form of vascular dementia it was not proven so. It is absolutely essential for doctors to have good background knowledge of diseases and all kinds of particularities accompanying old age, especially when it comes to the early detection of dementia. High consumption of Pentoxifyllin led to a number of experiments and studies trying to prove its efficiency and hence justify prescripcions for the drug. An extended study carried out in 1996 demonstrated the favourable effects of Pentoxifyllin. Our experiment has also showed signs of improvement in pateints with weaker forms of dementia. Final decision on the suitability of the treatment with...
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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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Biological properties of non-functioning pituitary adenomas.
Česák, Tomáš ; Náhlovský, Jiří (advisor) ; Smrčka, Martin (referee) ; Paleček, Tomáš (referee)
Introduction: Non-functioning pituitary adenomas (NFPAs) are regarded as benign, slowly growing tumours of the sella turcica region. Their growth is generally constantly exponential; however, rapid and aggressive proliferation is not the exception, especially in young patients. Treatment involves surgical removal. In literature, the role of postoperative irradiation of the residual tumour is controversial. Aim: The aim of this study was to investigate the natural growth patterns of NFPAs and attempt to identify the factors affecting their growth potential. As part of the study, nuclear marker Ki-67 was tested as a possible reliable indicator of adenoma proliferation, as well as it's role as a potential marker of postoperative remnant's growth potential. This would enable the identification of serious rapid growth in cases of tumour recurrence. Material: Our study is based on 105 patients operated for NFPAs between years 2000-2007. The fixed inclusion criteria of the study (a postoperative residue detected by 2 graphic examinations, absence of adjuvant therapy and the imunohistochemical determination of the proliferation marker) were fulfilled by 29 patients (22 men, 3 women). The average age of the patient group was 62.9 years. By large, the tumours were afunctional macroadenomas with gonadotrophin...
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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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