Viktor Matejčík

Craniopharyngiomas in children: how radical should the surgeon be?

PurposeTwo main modes of management of craniopharyngiomas, namely, radical tumor removal and intentional incomplete removal followed by radiotherapy, are used. Recently, a half-way solution was added. Radical removal is reserved only for the tumors not involving hypothalamus. Such tumors, however, are not clearly defined. The goal of the study was to clarify the relationship of craniopharyngiomas with surrounding structures, especially hypothalamus, and to evaluate its clinical significance.MethodsOur policy of management of craniopharyngiomas was elaborated on the basis of the results of morphological studies of the topography and their correlation with magnetic resonance imaging (MRI) in 115 adults and children operated on since 1991. Suitability of the policy in children and adolescents was verified by long-term outcome analysis in 41 consecutive patients.ResultsThe rate of morbidity and mortality was higher in patients with craniopharyngiomas located inside the third ventricle either partially (intraventricular and extraventricular craniopharyngiomas, IEVCs, 16 patients) or completely (intraventricular, one patient) than in tumors located outside the ventricle (suprasellar extraventricular, SEVCs, five patients; intrasellar and suprasellar, 19 patients). Postsurgical hypothalamic signs and symptoms occurred most often in intraventricular tumors; there were no mental disorders or obesity caused by primary removal of SEVCs including those severely compressing hypothalamus.ConclusionsRadical removal of SEVCs is safer than of IEVCs despite an apparent involvement of hypothalamus. In majority of cases, they may be distinguished by indirect MRI signs; in others only according to operation findings; final decision about the optimal extent of tumor removal should be made during surgery.

Peripheral nerve reconstruction by autograft

The purpose of this retrospective clinical study was to present the results achieved by microsurgical reconstruction of peripheral nerve injuries in the 15 years between 1985 and 1999. Sixty patients underwent 63 surgical procedures. Forty-five nerves were reconstructed by autograft in 42 patients with injuries of the upper extremities; 14 patients had lower limb peripheral nerve reconstruction. The facial nerve was reconstructed by autograft in four patients. Factors that could possibly affect the results, such as delaying surgery, age of the patient, nature of the injury, length of the autograft, height of the injury and type of nerve damage, were assessed. The results were better in the reconstruction of nerve injuries in the upper than the lower limbs. Reconstruction of the tibial nerve was also rewarding. In general, the results of facial nerve reconstruction were good. The time between injury and reconstructive surgery was a crucial factor for successful outcome, especially in younger patients.

Surgical location and anatomical variations of pudendal nerve.

An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture.

Intraspinal extradural variations of nerve roots

INTRODUCTION The aim of this work is to point out the intraspinal extradural anatomical variations of nerve roots and their possible participation in radiculopathy. METHODS The anatomical study was performed in 33 cadavers at a mean age of 46.5 and up to 24h from death. All extradural anastomoses between nerve roots were excised and examined histologically for the presence or absence of nervous tissue. The type of the plexus was defined by subtracting from the root C2. RESULTS Findings with the normotype of plexus formation prevailed in 24 cases (72.7%). Variations in its formation were observed in 9 cases (27.3%). The prefixed type in 6 cases (18.2%), post-fixed type in 3 cases (9.1%). We did not observe the formation of the isolated prefixed or post-fixed types in the brachial or lumbosacral plexuses. Extradural anatomical variations occurred in 20 cases (60.6%). They were more frequent on the left, in 10 cases (30.3%), bilateral in 3 cases (9.1%). In 8 instances (24.2%), the atypical spacing, including four in the lumbosacral region, was observed. Variations occurred more frequently in variations of formation of the plexus. CONCLUSIONS This study allowed us to identify and describe unpublished intraspinal extradural anatomical variations of nerve roots and their interrelationships throughout the spinal canal with their potential influence on the clinical picture. Anatomical preparations revealed a higher incidence of intraspinal extradural variations, mainly between sacral roots. The reliance of their incidence of the type of plexus was observed.