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Atypical intracranial vascular malformations: their behavior, treatment and follow-up
Voldřich, Richard ; Netuka, David (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
Therapy and follow-up of patients with atypical vascular malformations are not standardized. The goals of this dissertation are the comparison of relevant treatment and imaging methods, the determination of an optimal follow-up program based on the type of lesion or the character of therapy, and the documentation of the behavior of atypical malformations after incomplete closure. Long-term observation of 195 embolized dural arteriovenous malformations (DAVM) confirmed the high success rate of Onyx embolic material compared to other agents - complete occlusion was achieved in 88% of cases compared to 35% in the control group. A total of 93% of DAVMs treated with Onyx were closed at the last follow-up. The material also proved to be stable in the long term. Recurrence was diagnosed in 1,8% of patients. The recurrences of DAVM occur due to the accentuation of originally negligible vascular fistulas that are not visible on post-interventional digital subtraction angiography (DSA). Prospective comparison of magnetic resonance angiography (MRA) and DSA concluded that patients after complete embolization of dural fistula can be safely followed using only MRA. In the case of carotid-cavernous fistulas (CCFs), imaging and clinical outcomes of traditional and new endovascular materials, as well as...
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Effect of Surgical Cerebral Revascularization on Hemodynamics, Clinic and Neurocognitive Performance
Košťál, Petr ; Přibáň, Vladimír (advisor) ; Grus, Tomáš (referee) ; Šámal, Filip (referee)
4 Abstract Introduction Since 2016, we know that the neuron responds to chronic hypoperfusion by reducing its performance. Cerebral revascularization using extra-intracranial bypass in internal carotid occlusion has also been shown to improve this reduction in function. In the case of asymptomatic internal carotid stenosis (ACS), hypoperfusion of the brain may occur due to insufficient collateralization. It is not clear whether this condition can lead to changes in cognitive performance. Likewise, the impact of hemodynamic changes on cognition in patients with ACS after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at one year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency. Methodology As part of the prospective study, the flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at one year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for analyses with changes in cognitive skills after CEA. Results One year...
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Methods and consequences of some neurosurgical interventions in animal model and in human clinic. Pinealectomy and intracerebroventricular application.
Řezáčová, Lenka ; Tichý, Michal (advisor) ; Szárszoi, Ondrej (referee) ; Přibáň, Vladimír (referee)
Clinical surgical techniques of pinealectomy and intracerebroventricular (i.c.v) cannulation are still used in the clinic in indicated cases. In research, there is an effort to replace these classical surgical techniques by other means. However, these various new models often do not reflect the complexity of the functions taking place in the living organism as a whole. The thesis shows that these surgical techniques should be also a part of biomedical research in the future, as they still bring new important information. In the experiment, the pinealectomy can serve as a model of resection or depletion (removal of natural hormone secretion), while i.c.v. application of the active substance to the ventricles on the contrary as a model of addition or substitution. The practical part of the thesis is divided into 4 areas: A) pinealectomy - an animal models, B) pinealectomy - in the experiment, C) pinealectomy - in the clinical practice and D) intracerebroventricular application - in the experiment. The work describes in detail the surgical techniques and discuss possible consequences of pinealectomy in 6 animal species (and their comparison) and in humans. It also includes an experiment with pinealectomy in a rat and a clinical study in patients with pineal cyst and subsequent pinealectomy. The work...
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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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Factors Influencing the Radicality of Resection During Endoscopic Endonasal Transsphenoidal Potuitary Surgery.Intraoperative Magnetic Resonace Imaging in a Traditional Imaging Suite During Endonasal Pituitary Adenoma Resection.
Vacek, Petr ; Přibáň, Vladimír (advisor) ; Brichtová, Eva (referee) ; Lipina, Radim (referee)
Objective: Our primary goal was to evaluate our experience with performing intraoperative magnetic resonance imaging (iMRI) in a traditional MRI suite during endoscopic endonasal pituitary adenoma resection. Methods: From March 2008 to February 2013 a single department performed endoscopic endonasal pituitary adenoma resection on 50 patients. Surgical outcomes were compared between the first 25 patients (no iMRI) and the second 25 patients with whom iMRI was used. We evaluated not only the number of total resections in both groups, but also the prolongation of the time of the surgery in the second group. We also evaluated the progression of ophthalmic and endocrinological symptoms in both groups and the rate of complications. Results: The average length of the surgery was prolonged from 205 to 238 minutes (marginally statistically insignificant). We achieved total adenoma resection in seven cases (28%) in the first group and in 16 cases (64%) in the second group (a statistically significant difference). iMRI was successfully performed on all the patients in the second group without any complications related to patient transport or the execution of the imaging. There were no statistically significant differences in diabetes insipidus occurrence, postoperative visual field improvement, or...
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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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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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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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The Surgical Treatment Options in Thoracolumbar Spine Degeneration: The Importance of Morphological and Clinical Classifications in Preoperative Decision Making
Bludovský, David ; Přibáň, Vladimír (advisor) ; Chaloupka, Richard (referee) ; Rudinský, Bruno (referee)
The surgical treatment options in thoracolumbar spine degeneration: The importance of morphological and clinical classifications in preoperative decision making David Bludovský Abstract: Objective: The aim of our study was to investigate the relations between subjective difficulties, clinical findings and the MR imaging in patients who have been operated for symptomatic lumbar spinal stenosis (LSS), and the possibility of using these relations for surgical treatment decision. Methods: Patients operated for lumbar spinal stenosis in 2009-2010 were included in the study. Subjective difficulties were assessed using the Oswestry Disability Index (ODI), the clinical symptoms with the modified Neurological Impairment Score for Lumbar Spinal Stenosis (mNIS-LSS). We measured the spine canal area, dural sac area, and nerve root sedimentation classification on MR. By correlation analysis at significance level p <0.05, we tested the relations between these categories. 61 patients with a median age of 67 were included. Overall, we evaluated 162 spinal segments. Results: Median of ODI values were 48. Correlation coefficients for ODI, mNIS-LSS and graphical findings were less than 0.5. Correlation coefficients greater than 0.5 were between all the MR measurement methods. Conclusions: In the group of patients indicated...
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Optimalised indications for microsurgical and endovascular treatment of intracranial aneurysms.
Štekláčová, Anna ; Beneš, Vladimír (advisor) ; Přibáň, Vladimír (referee) ; Zvěřina, Eduard (referee)
Univerzita Karlova v Praze 1. lékařská fakulta Autoreferát disertační práce Optimalizace indikací chirurgického a endovaskulárního ošetření intrakraniálních aneurysmat Anna Štekláčová 2018 2 Doktorské studijní programy v biomedicíně Univerzita Karlova v Praze a Akademie věd České republiky Obor: Neurovědy Předseda oborové rady: Prof. MUDr. Karel Šonka, DrSc. Školicí pracoviště: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN, Praha Školitel: Prof. MUDr. Vladimír Beneš, DrSc. Disertační práce bude nejméně pět pracovních dnů před konáním obhajoby zveřejněna k nahlížení veřejnosti v tištěné podobě na Oddělení pro vědeckou činnost a zahraniční styky Děkanátu 1. lékařské fakulty. 3 Obsah Abstrakt - Česky ..................................................................................... 4 Abstract - English ................................................................................... 5 Úvod........................................................................................................ 6 Hypotézy a cíle studie............................................................................. 6 Materiál a metody ................................................................................... 7 Výsledky...
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