Grzegorz Turek

Expression of MMP-9 and VEGF in meningiomas and their correlation with peritumoral brain edema.

Meningiomas constitute up to 13% of all intracranial tumors. The predictive factors for meningioma have not been unambiguously defined; however some limited data suggest that the expression of matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) may be associated with the presence of peritumoral brain edema (PTBE) and worse clinical outcome. The aim of this study was to analyze the expressions of MMP-9 and VEGF in a group of meningiomas of various grades and to study associations between these two markers and PTBE. The study included patients with supratentorial meningiomas. The patients were divided into low- (G1) and high-grade meningiomas (G2 and G3). PTBE was assessed on MRI. The expressions of VEGF and MMP-9 were determined immunohistochemically. The expression of MMP-9 was observed significantly more often in G3 meningiomas than in lower grade tumors. The presence of stage II or III PTBE was associated with a significant increase in MMP-9 expression. The expression of VEGF did not differ across the PTBE stages. Our findings point to a significant role of MMP-9 and VEGF in the pathogenesis of peritumoral brain edema in low- and high-grade meningiomas.

Normal reference values of ratios of blood flow velocities in internal carotid artery to those in common carotid artery using Doppler sonography.

The ratios of of blood flow velocities in the internal carotid artery (ICA) to those in the common carotid artery (CCA) (VICA/VCCA) are used to identify patients with critical ICA narrowing, but their normal reference values have not been established. We provide reference data for the VICA/VCCA ratios for the peak systolic velocity (PSV), mean velocity (MV), and end‐diastolic velocity (EDV) measured in a large group of healthy subjects.

Influence of Smoking Cigarettes on Cerebral Blood Flow Parameters

Introduction: While chronic cigarette smoking can lead to increased risk of stroke, the acute effects of smoking have not been established. We studied the changes in blood flow parameters in the major cerebral arteries caused by smoking one cigarette. Method: Using transcranial color-coded sonography (TCCS), we studied the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and the internal carotid artery (ICA) of 36 healthy male volunteers before and after they smoked one cigarette. Results: Blood flow velocity increased to a different degree in all but one of the arteries examined after participants smoked a single cigarette: The end diastolic velocity increased significantly by 7.8% in the PCA, 8% in the ACA, and 14.4% in the MCA. The peak systolic velocity increased significantly by 7.5% in the MCA. Blood flow velocity remained unchanged in the ICA only. Blood pressure and heart rate increased as did the flow velocity ratio for the MCA/ICA. The pulsatility index decreased after smoking from 0.92 ± 0.13 to 0.87 ± 0.14 in the MCA, 0.93 ± 0.15 to 0.87 ± 0.13 in the ACA, and 0.95 ± 0.17 to 0.89 ± 0.16 in the PCA. Conclusions: The results suggest that the direct effect of smoking on cerebral circulation includes peripheral vasodilatation with possible constriction of the main trunk of the basal cerebral arteries.

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: First clinical experience

BACKGROUND AND PURPOSE Recently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. MATERIAL AND METHODS In emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. RESULTS In both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. CONCLUSIONS Our experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored.

Diagnostyka ultrasonograficzna i wewnątrznaczyniowe udrożnienie tętnicy po embolizacji tętniaka mózgu powikłanej zakrzepem tętnicy szyjnej wewnętrznej

Streszczenie Powiklania zatorowo-zakrzepowe po leczeniu wewnątrznaczyniowym tetniakow mozgu stanowią zagrozenie zycia, ale wciąz leczone są najcześciej zachowawczo. Rzadko stosowaną alternatywą jest interwencja wewnątrznaczyniowa, ktorej skutecznośc ściśle zalezy od czasu jej przeprowadzenia. Niniejszy opis przypadku podkreśla uzytecznośc przezczaszkowej ultrasonografii z kolorowym obrazowaniem przeplywu krwi w szybkim rozpoznaniu roznicowym oraz skutecznośc natychmiastowej interwencji drogą wewnątrznaczyniową. U 50-letniej chorej po zabiegu ponownej embolizacji tetniaka tetnicy szyjnej wewnetrznej doszlo do wystąpienia objawow neurologicznych. Badanie dopplerowskie wykazalo zmniejszenie predkości przeplywu krwi w tetnicy środkowej mozgu, a angiografia – prawie calkowitą niedroznośc tetnicy szyjnej wewnetrznej. Podano heparyne, wykonano pilną trombektomie drogą wewnątrznaczyniową i zalozono do naczynia stent, uzyskując ustąpienie objawow. Przezczaszkowa ultrasonografia dopplerowska z kolorowym obrazowaniem przeplywu krwi pozwala szybko rozpoznac powiklania po embolizacji tetniakow mozgu związane z zaburzeniem przeplywu krwi w naczyniach wewnątrzczaszkowych. Umozliwia to szybką i skuteczną interwencje wewnątrznaczyniową w przypadku powiklan zatorowo-zakrzepowych.Thromboembolism after brain aneurysm embolization involves high morbidity/mortality and its conservative treatment is still a standard policy. We report the practical utility of transcranial colour-coded Doppler sonography (TCCS) in the early diagnosis and effectiveness of prompt intravascular intervention in the treatment of this condition. A 50-year-old woman developed acute neurological deficit after intravascular re-embolization of a brain aneurysm. Severely decreased blood flow velocity in the middle cerebral artery was revealed with TCCS and angiography confirmed nearly complete occlusion of the carotid artery. After heparin administration, intravascular thrombectomy was performed at the same session with implantation of a stent. The symptoms faded away within hours and the patient recovered fully. Prompt intravascular intervention could be a valuable and efficient alternative in the treatment of thromboembolism after embolization of cerebral aneurysm. TCCS enables early differential diagnosis of this potentially devastating sequel.

Blood flow velocity in the middle cerebral artery during transnasal endoscopic skull base surgery performed in controlled hypotension.

BACKGROUND AND PURPOSE To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters. MATERIALS AND METHODS In 40 patients who underwent endoscopic skull base surgery in controlled hypotension (studied group) and in 13 patients operated without reduction of hemodynamic parameters (control group), blood flow velocity in MCA was assessed with transcranial color Doppler sonography. RESULTS Blood flow velocity in MCA remained within the range of age-specific reference values in all patients before operation. It decreased significantly in both groups after induction of anesthesia and then dropped even further in studied group of patients when hemodynamic parameters were reduced; the systolic velocity fell below the normal reference values in 25% of patients, the mean velocity in 50% and the diastolic velocity in 57% of patients. The diastolic velocity was much more heavily influenced by diminished hemodynamic parameters than systolic velocity in the studied group as opposed to the control group where reduction of blood flow velocity pertained equally systolic and diastolic velocity. CONCLUSION During transnasal endoscopic procedures performed in moderate hypotension, in addition to significant drop of blood flow velocity to values well below the normal reference range, a divergent reduction of systolic and diastolic velocity was detected. Since divergent systolic and diastolic velocity may indicate an early phase of cerebral autoregulation compromise, and the decrease of mean blood flow velocity in MCA corresponds with a decrease of cerebral blood flow, further investigations in this field seem warranted.

Early Intraocular Complications of Subarachnoid Haemorrhage after Aneurysm Rupture

Abstract The aim of this study was to identify factors predisposing for early intraocular complications of aneurysmal subarachnoid haemorrhage (SAH). The authors analysed 96 selected cases of aneurysmal SAH. Forty patients (42%) demonstrated abnormal fundus findings, including disc swelling (13.5%), retinal haemorrhages (23%), and vitreous haemorrhage (5%). The incidence of intraocular pathologies was significantly higher in patients who lost consciousness at the onset of SAH, were admitted with high scores of the Hunt-Hess and Fisher scales and low score of the Glasgow Coma Scale, as well as in those with arterial hypertension, more sizable aneurysm, and older.

MMP-9 and/or TIMP as predictors of ischaemic stroke in patients with symptomatic and asymptomatic atherosclerotic stenosis of carotid artery treated by stenting or endarterectomy – A review

We still lack an optimal tool to predict ischaemic stroke in patients with symptomatic and asymptomatic carotid stenosis (CS). It has already been shown that patients at increased risk of ischaemic stroke can be identified based on the elevated plasma levels of metalloproteinases (MMPs) and reduced activity tissue inhibitor of metalloproteinase (TIMP). There are few studies presenting the role of MMP-9 and TIMP in ischaemic stroke both in patients with symptomatic and asymptomatic CS treated with stenting or endarterectomy, however we have not found any published review summarizing the role of abovementioned markers. MEDLINE was accessed via Pub Med, and searched for published studies that analyzed MMP-9 and TIMP levels in patients with asymptomatic and symptomatic internal carotid stenosis and/or examined these parameters as potential risk markers for ischaemic stroke. A total of 13 articles documenting the outcomes of patients with symptomatic or asymptomatic carotid stenosis treated by carotid stenting or endarterectomy, were analyzed. Statistically significant differences in the levels of MMP-9 and/or TIMP in patients with symptomatic and asymptomatic CS have been reported. Also the concentrations of MMP-9 and TIMP in CS patients subjected to stenting or endarterectomy were higher than in baseline group. Moreover higher levels of MMP-9 and decreased TIMP was reported to be associated with the risk of restenosis. This systematic review shows that available evidence regarding the dynamics of MMP-9 and TIMP levels may be a predictor of cerebrovascular events in both symptomatic and asymptomatic carotid stenosis in patients treated with stenting or endarterectomy.

Expression of N-cadherin and β-catenin in human meningioma in correlation with peritumoral edema

ABSTRACT Objective: To analyze the expression of β-catenin and N-cadherin in large series of meningioma cases and to investigate their correlation with peritumoral brain edema (PTBE). Materials and methods: Study group consists of 154 patients diagnosed with intracranial meningioma divided into: low-grade (G1) and high-grade (G2 or G3) group. PTBE was graded into four groups (0, I, II, III) using Steinhoff classification. The expression of N-cadherin, β-catenin was analyzed and graded based on the positive ratio of immunoreactivity. The results were analyzed statistically. Results: 104 cases were low-grade and 50 high-grade meningiomas. PTBE was observed in 103(66.8 %) cases: 57 grade I, 44 grade II and 2 grade III. Positive N-cadherin expression was found only in the membrane of the neoplastic cells in 50(48.1%) cases of low-grade, and in 34(68%) of high-grade group. In low-grade meningioma, β-catenin expression was observed within the cytoplasm and nucleus in 54(51.9%) cases. In high-grade meningiomas, β-catenin expression was observed in 33(66%) tumors only within the nucleus. N-cadherin expression was observed in 36 cases with PTBE grade I, 28 with grade II and 2 with grade III. β-catenin expression was observed in 40 cases with PTBE grade I, 24 with grade II and 2 with grade III. The results were statistically significant. Conclusions: Significant N-cadherin expression especially in high-grade meningioma group was found. β-catenin expression was the most evident in the nucleus rather than in cytoplasm. The degree of PTBE correlated with the N-cadherin and β-catenin expression and was the most prominent in high-grade meningioma group.

Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm

Late ocular manifestations of aneurysmal subarachnoid hemorrhage (SAH) have not been previously investigated except for one study which demonstrated that one half of patients subjected to aneurysm clipping suffer from symptoms of visual pathway impairment. We assessed ophthalmological status of patients after 1-4.5 years from SAH and aneurysm embolization to identify predictors of damage to the visual pathways. Complete ophthalmological examination, static perimetry, and visual evoked potentials (VEPs) were performed in 74 patients (26 men, 48 women, aged 19-76 years), who constituted a consecutive sample of 129 patients treated with aneurysm embolization in the years 2008-2010. The following independent variables: sex, age, time from SAH to embolization, size and site of aneurysm, score in Glasgow Coma Scale, Glasgow Outcome Scale, Hunt-Hess and Fisher scales were subject to univariate and multivariate statistical analyses to study their influence on the ocular outcome. 40 patients (54%) demonstrated visual field defects appearing as multiple peripheral foci and constricted field, affecting both eyes. Among these subjects, 12 patients had severe defects in the visual field, 20 had deterioration in VEPs, and 9 had decreased visual acuity. Older age and high score in Hunt-Hess and Fisher scales were identified as predictors for visual field defects and disturbances in VEPs. More than half of the survivors of SAH and aneurysm embolization suffer from a permanent defect in visual function. Damage of visual pathway correlates with severity of SAH and older age of patients.