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Skull Base Meningiomas
May, Michaela ; Beneš, Vladimír (advisor) ; Smrčka, Martin (referee) ; Suchomel, Petr (referee)
This dissertation is a set of 5 studies focused on skull base meningiomas. The anatomical study explored the dislocation of the outer and inner arachnoid membranes by the skull base meningiomas. The findings can be applied during surgical resection to predict the presence or absence of the arachnoid dissection plane and the adherence of critical neurovascular structures. The Czech multicentric study documented overall survival 98.1 %, morbidity 13.2 %, and mortality 1.3 %. Predictive factors of histological grade, the extent of resection, clinical outcomes, risk of recurrence and progression were analyzed. Petroclival meningiomas originating within the interpeduncular and prepontine cisterns were the most surgically challenging. Our prospective study focused on the examination of olfaction in olfactory groove meningiomas. The predictors of olfaction preservation were intact olfaction, lower volume and unilateral surgical approach. Olfaction examination is essential to choose surgical strategy and evaluate functional outcome. In a retrospective study of Simpson grade IV resections, adjuvant stereotactic radiosurgery was associated with longer progression-free survival, time-to- progression, and overall survival. Due to the high percentage of progressions (50 %) and the long overall survival (10...
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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 brain infarct core delineation using computed tomography angiography source images in acute stroke patients
Rohan, Vladimír ; Choc, Milan (advisor) ; Kalvach, Pavel (referee) ; Kalita, Zbyněk (referee) ; Smrčka, Martin (referee)
Background and Purpose: Ischemic stroke is the 3rd most common cause of death and most common cause of permanent disability in developed countries. Rapid diagnostic work-up with reliable assessment of infarcted brain tissue and potentionally salvageable brain tissue is critical for acute stroke management. The first aim of this study is to asses delineation of infarct core in acute stroke patients using whole brain perfused blood volume (PBV) maps. These maps are calculated by automatic processing from computed tomography angiography source images (CTA-SI) and non-contrast computed tomography (NCCT) data. The second aim is to determine optimal quantitative threshold of PBV for infarct core identification in acute stroke setting. Material and methods: PBV maps were constructed using prototype software from NCCT and CTA-SI data in 37 acute ischemic stroke patients with angiographically proved recanalization after intravenous thrombolytic treatment. These PBV maps were automatically compared with final infarct extension on follow-up NCCT. The anatomic pixel-by-pixel correlation was assessed using Matthew's correlation coefficient (MCC) for infarct core delineation using different critical values of PBV. The optimal threshold with the best correlation was used for infarct volume computation. Minimal PBV...
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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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The correlation of intracranial pressure and next investigative parameters at the cerebral contusion
Škúci, Ivan ; Choc, Milan (advisor) ; Novák, Zdeněk (referee) ; Smrčka, Martin (referee)
Patients with a brain injury must overcome a central neurological insult and a systematic metabolic response. The systematic response includes hypermetabolism, hypercatabolism, altered vascular permeability, increased hormone and cytokine release, altered gastric emptying, altered mineral metabolism and altered immune status. This response may initiate mechanisms which lead to secondary brain injury and may adversely affect the function of other organs. Last two decades have improved our knowledge of pathophysiology in patients with primary and secondary brain injury including traumatic contusions. In a moment of injury, primary brain injury which is traumatic contusion can not be therapeutically prevented it can only have a preventive effect. Secondary brain injury can be therapeutically affected although both types of injuries have common pathophysiological signs of disturbed metabolism on cells and subcellular level. Research methods based on molecular biology opens a new zone of research reaction of central neurological system for trauma or ischemia with effort to get involved immediately at the beginning of developing adverse pathophysiological cascade leading to a death of neurotic cell. The brain contusion is a primary centre of brain injury with anatomic changes which can be graphically proved. In...
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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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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 brain infarct core delineation using computed tomography angiography source images in acute stroke patients
Rohan, Vladimír ; Choc, Milan (advisor) ; Kalvach, Pavel (referee) ; Kalita, Zbyněk (referee) ; Smrčka, Martin (referee)
Background and Purpose: Ischemic stroke is the 3rd most common cause of death and most common cause of permanent disability in developed countries. Rapid diagnostic work-up with reliable assessment of infarcted brain tissue and potentionally salvageable brain tissue is critical for acute stroke management. The first aim of this study is to asses delineation of infarct core in acute stroke patients using whole brain perfused blood volume (PBV) maps. These maps are calculated by automatic processing from computed tomography angiography source images (CTA-SI) and non-contrast computed tomography (NCCT) data. The second aim is to determine optimal quantitative threshold of PBV for infarct core identification in acute stroke setting. Material and methods: PBV maps were constructed using prototype software from NCCT and CTA-SI data in 37 acute ischemic stroke patients with angiographically proved recanalization after intravenous thrombolytic treatment. These PBV maps were automatically compared with final infarct extension on follow-up NCCT. The anatomic pixel-by-pixel correlation was assessed using Matthew's correlation coefficient (MCC) for infarct core delineation using different critical values of PBV. The optimal threshold with the best correlation was used for infarct volume computation. Minimal PBV...
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