Lech Polis

Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods

Objective: The authors intended to evaluate the application of neuroendoscopic techniques for the treatment of arachnoid cysts in children and compare it with other operative methods. Methods: The analysis covered the results of treatment of 44 children with arachnoid cysts who were subjected to neuroendoscopic procedures and 62 patients who underwent other operations. Results: The neuroendoscopic treatment of arachnoid cysts was very effective because of low rate of reoperative treatment (six out of 44 patients), no need to change the operative method (40 effective out of total 44 operative procedures), and low rate of persistent worsening (none of 44 patients worsened). Conclusions: Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.

Effectiveness of neuroendoscopic procedures in the treatment of complex compartmentalized hydrocephalus in children

ObjectiveThe main object of the work is to assess the suitability of neuroendoscopic techniques for the treatment of complex compartmentalized hydrocephalus.MethodsFor this purpose the authors compared two groups of children treated in the Research Institute of the Polish Mothers Memorial Hospital from March 1997 to January 2002. The first group of 47 children, treated using neuroendoscopic procedures, was compared with the second, which comprised 80 children treated conventionally by complicated shunt implantations.ResultsThe children treated neuroendoscopically needed on average 1.7660 procedures during the entire therapy, and 1.0232 operations a year. The same parameters in the conventionally-treated group were as follows: the total number of procedures was 7.050, and the rate of reoperation was 3.949 procedures a year. The proportion of patients who suffered from complications connected with operative treatment and who had a bad outcome was higher in the conventionally-treated group than in the neuroendoscopic one.

Ultrastructural heterogeneity of gangliogliomas.

Gangliogliomas are rare brain tumors, composed of neuronal and glial cells mixed in a different proportion. The basic histopathological pattern of gangliogliomas is well recognized but the variable microscopic appearance still can pose a challenge to the neuropathologist. The authors reanalyzed their series of gangliogliomas in the files of two departments of neuropathology. All analyzed tumors fulfilled the WHO histological criteria of ganglioglioma. Seven tumors were examined by electron microscopy. The following ultrastructural features were graded: presence of dense-cored vesicles, synaptic vesicles, synapses and intermediate filaments, abundant basal membranes, dystrophic neurites, autophagic vacuoles, and multivesicular bodies. Most of the neoplastic neurons were large, polyglonal or oval with well-developed subcellular organelles, round nuclei, and prominent nucleoli. In most cases there were abundant dense core vesicles, observed in both the tumor cell bodies as well as in their processes. Synapses were typically observed. Intermediate filaments were abundant in all tumors. The most intriguing ultrastructural finding was abundant presence of autophagic vacuoles. In 4 cases, multivesicular bodies were observed. All of the tumors with multivesicular bodies also contained abundant autophagic vacuoles.

Raman spectroscopy for medulloblastoma

PurposeThe aim of the study is to use Raman spectroscopy to analyze the biochemical composition of medulloblastoma and normal tissues from the safety margin of the CNS and to find specific Raman biomarkers capable of differentiating between tumorous and normal tissues.MethodsThe tissue samples consisted of medulloblastoma (grade IV) (n = 11). The tissues from the negative margins were used as normal controls. Raman images were generated by a confocal Raman microscope—WITec alpha 300 RSA.ResultsRaman vibrational signatures can predict which tissue has tumorous biochemistry and can identify medulloblastoma. The Raman technique makes use of the fact that tumors contain large amounts of protein and far less lipids (fatty compounds), while healthy tissue is rich in both.ConclusionThe ability of Raman spectroscopy and imaging to detect medulloblastoma tumors fills the niche in diagnostics. These powerful analytical techniques are capable of monitoring tissue morphology and biochemistry. Our results demonstrate that RS can be used to discriminate between normal and medulloblastoma tissues.

Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection

PurposeThe aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120–123, 2017; Hayhurst et al. Childs Nerv Syst 24:557–562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795–1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131–136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792–797, 2012).MethodsThe study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation.ResultsIn the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins.ConclusionCSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.

The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus—a preliminary report

IntroductionRecognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly.AimThe aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus.Materials and methodsA group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms.ResultsThe peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters.ConclusionPhase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

Early Vertebrectomy (Performed in First 72 Hours after Delivery) as a Treatment Method of Vertebral Column Deformation in Patients with MMC

Introduction 8–12% of all dysraphic defects are accompanied by vertebral column deformations like gibbus, that makes a skin closure a very complicated procedure. The presence of lumbar kyphosis in children who suffered from myelomeningocele increases thread of wound dehiscence, large skin necrosis, CNS infections, decubitus ulcer etc. Operative treatment of vertebral column deformations comprise reduction of pathological curvature to: reach a physiological balance of acting forces on vertebral column axis during upright position of a body, reduce a rate of vertebral column kyphosis increasing, minimize a skin tension over a gibbus, increase abdomen cavum capacity and improve breathing 72 hours after delivery is concerned as a critical moment of surgical management, that should not be exceeded. The main goal of the work is to asses efficiency of an early vertebrectomy performed during surgical management of dysraphic defect that makes possible: prevention from mentioned above complications, avoiding further surgical management and spine stabilization in the future. Material and Methods In Polish Mothers Memorial Hospital (PMMH) 572 surgical managements of dysraphic defects were performed between year 1992 and 2015. In 89 (15,6%) cases coexistence of pathological spine kyphosis was diagnosed. Myelomeningocele aperta was found to be most common type of DD in our material. All our procedures were performed in first 48 hours after delivery. In 15 cases it was in first 24 hours and in 16 it was in second 24 hours of living. During surgical management of Dysraphic Defect form 1 to 3 vertebral bodied were removed. Spine kyphosis side angle and height were measured. Height of gibbus was measured according to K-C straight and side angle was measured with Cobb-4 method Results After such a surgical management we achieve possibility to close skin defect with possible low tension and reduction of pathological spine kyphosis without any foreign material stabilization of the spine. By our surgical management we managed to reduce in average the side angle of the kyphosis by 52,4% and reduce the height in average by 48,06%. Height reduction of pathological spine kyphosis depends on height of pathological spine kyphosis before the surgical management. Side angle quantity of pathological spine kyphosis before the surgical management has statistically significant influence both on height of pathological spine kyphosis and quantity of height reduction after surgical management. Trophic disorders of postoperative wound right after surgery occurred in 12,9% of cases (4 patients) In all catamnesis period it occurred only in 7 cases that was 22,6% of all patients. Conclusion Early performed vertebrectomy with gibbus reduction in first 48 hour after delivery allow to: (1) Close dysraphic defect with coexisting large skin loss; (2) Reduce possibility of recurrent postoperative wound trophic disorders; (3) Reduce the growth rate of pathological spine kyphosis during child genesis. The severity of pathological spine kyphosis and occurrence of early postoperative wound trophic defects are predictors in dysraphic patients.