Biomedical subjects
Publications and source records attributed to A Marchel.
An extremely rare case of intramedullary spinal cord metastasis (Carcinoma solidum metastaticum) is presented. No primary tumour was found. The authors discuss diagnostic and therapeutic problems of treatment in such cases.
The value of the antifibrinolytic treatment was assessed in two groups od patients treated after subarachnoid haemorrhage from ruptured aneurysm. One group of 449 patients received EACA before the operation, and 308 were not given EACA. The effectiveness of this treatment was analysed considering the frequency of recurrent haemorrhages, site of aneurysm and sequelae of recurrent haemorrhage as well as ischaemic complications of subarachnoid haemorrhage. The frequency of recurrent haemorrhages was significantly lower in the group not treated with EACA, and the frequency of ischaemic complications of subarachnoid haemorrhage was significantly higher in those treated with EACA.
Explore the source record for details and available documents.
The authors present a clinical analysis of 42 patients with vertebro-basilar aneurysms considering symptoms, course and complications of subarachnoid haemorrhage and localization of aneurysms: 88% were admitted after SAH, 47.6% had basilar bifurcation aneurysm. The ischaemic deficits due to vasospasm were observed in 5.4% of cases. Rebleeding occurred in 29.7% of patients, most of them died. 23 patients were operated on. In 69.9% of cases the operation was successful. The operative mortality was 17.4%. Temporary third nerve palsy was the most often postoperative complication.
Giant cell glioblastoma (GCG-BM) with predominance of bizarre, multinucleated giant cells is a rare subtype of glioblastoma, however, its clinical behavior and histological features are still not fully understood. We report an unusual case of a heavily lipidized form of giant cell glioma corresponding mostly to GCGBM in a young patient with neurofibromatosis 1 (NF1). Histologically, the tumor revealed numerous characteristic histopathological features of giant cell glioblastoma including cellular pleomorphism with numerous giant tumor cells, pseudopalisades around necrotic foci and mitotic activity, accompanied by additional unique morphological elements such as massive lipidization of the neoplastic cells, abundant microcalcifications and angiomatous pattern of vascularization. Such aberrant morphology might be associated with the unusually long survival period of 12 years without clinical evidence of tumor recurrence. The coexistence of intracerebral heavily lipidized, calcified giant cell glioblastoma with NF1 has not been previously reported in literature.
A group of 73 patients is described in whom diagnostic procedures failed to demonstrate the source of haemorrhage. In this group 92% of patients were in good clinical condition after the episode (I and II clinical group). In only one patient with angiographically demonstrated diffuse vasospasm in one cerebral hemisphere signs of focal brain damage developed leading to death. The remaining 95.9% of patients left the hospital in good condition, without focal signs. During follow-up in two (3.2%) out of 62 patients with known condition a recurrence of subarachnoid haemorrhage developed. Most patients were in good condition, fully fit up to 3 years after the haemorrhage. In summary, the authors stress a mild course of subarachnoid haemorrhage of unknown aetiology, good prognosis as to return of full fitness, and relatively low risk of development of focal brain damage or death from haemorrhage.
The authors report preliminary experiences with preoperative embolization of intracranial meningiomas describing the technique using a specially prepared gelfoam as embolizing material. Embolization was done in 3 cases, in 2 of them transient facial nerve paresis appeared as complication. The effectiveness of embolization was assessed by means of selective control intraoperative angiography and histological examination. In the conclusions the authors stress the effectiveness of preoperative embolization for reducing intraoperative bleeding and indicate the usefulness of the procedure in selected cases of other brain tumours.
Results are presented of surgical treatment of patients with isolated aneurysms on the middle cerebral artery on the basis of the material of the Department of Neurosurgery, Medical Academy in Warsaw in the years 1975-1981. The material included 161 surgically treated patients out of 179 treated in this time period for diagnosed isolated aneurysm of this artery. The frequency of this aneurysm was 23.2% in this material. The operative mortality was 8.9%, and the results were very good and good in 85.7% of cases. The number of past bleedings from the aneurysm, the clinical state of the patients, the timing of the operation, presence of intracerebral haematoma, intraoperative rupture of the aneurysm and postoperative vasospasm were factors having a significant unfavourable influence on the early postoperative results. Vasospasm was the most frequent postoperative complication observed in 15.2% of cases. The clinical state of the patient and the mode of aneurysm management had a statistically significant effect on the late results of surgical treatment. In 6 cases (6.1%) subarachnoid bleeding appeared after the operation and in 5 of them aneurysm wall had to be strengthened (wrapping).
The authors report their preliminary experiences with early (within 72 hours after haemorrhage) operations in cases of intracranial aneurysms. Out of 131 patients operated on from April 1985 to March 1986 in the Department of Neurosurgery, Medical Academy in Warsaw 20 were qualified for surgical intervention immediately after haemorrhage. In 13 cases Nimodipine (Nimotop) was given locally during the operation and in the postoperative period. The schedule of drug administration is shown. In 15 cases (75%) a very good result was noted, in 3 (15%) major signs of focal brain damage were observed within 6 months after the operation. Two patients (20%) died. In 4 cases neurological focal signs developed 4-5 days after subarachnoid haemorrhage due to ischaemia confirmed with CT. The operative conditions during early operations, and the approach to the vessels at the base of the brain were as good as during delayed operations.
The authors present a case of posttraumatic cerebrospinal fluid rhinorrhoea developing 8 years after skull trauma. The rarity is discussed of the development of remote traumatic rhinorrhoea without previous symptoms of cerebrospinal fluid fistula, and the diagnostic difficulties are stressed in cases of such late rhinorrhoea. A new preparation used for plastic operation on the anterior cranial fossa floor is described.
Problem of surgical treatment in the elderly is still discussed in the literature. This group of patients needs especially clear criteria of qualification for extensive intracranial procedures. The authors present their own experience with 35 patients over 70 years old with intracranial tumours and intracranial aneurysms treated in Department of Neurosurgery, Warsaw Medical School between 1992-1993. Among 11 patients treated conservatively, only 3 patients were in poor physical state with functional limitation which was a contraindication for surgery. Postoperative mortality was 4.2%. On the basis of our experience we think that patients over 70 years can be safely operated on intracranial lesions and the age is not a contraindication for neurosurgical procedures.
The authors evaluate in the presented prospective study the incidence of late epilepsy after aneurysm surgery. 121 consecutive patients were operated on for ruptured aneurysm and were discharged home without any prophylactic anticonvulsant treatment and were followed-up for 12 months. The diagnosis of late epilepsy was made, if two or more seizures occurred during that time. Epilepsy occurred in 8 patients, so the incidence was 7%. Additionally in 3 patients a single seizure was observed during follow-up time but any anticonvulsant treatment was installed and the seizures did not recur for up to 24 months. The analysis of epileptic patients showed that in most of them the aneurysm was located on MCA and SAH was complicated by intracerebral haematoma or symptomatic vasospasm. On the basis of own experience and review of the literature the authors discuss the necessity of anticonvulsant prophylaxis after aneurysm surgery.
Explore the source record for details and available documents.
A case of cauda tumour (neurolemmona) is reported in which the presenting symptom was subarachnoid haemorrhage. The investigations for suspected cerebral vascular malformation brought no results. Only after appearance of clinical signs of cauda damage vertebral canal investigations made possible the correct diagnosis and proper treatment.
Own experience is presented in the administration of prophylactic antibiotic treatment in clean neurosurgical operations. The clinical material comprised 131 patients subjected to 138 operations. For prophylaxis ceftriaxone (Rocephin "Roche") was given by the so called short term programme in which 2 g of the drug was given intravenously before the operation, and 1 g after 24 hours. The frequency of postoperative infections was 0.7% in the group. The effectiveness is stressed of the short-term programme of prophylactic antibiotic treatment in the prevention of postoperative infections in neurosurgery emphasizing that operations in emergency cases, perioperative steroid therapy, tumours, craniotomy with free bone flap do not reduce the effectiveness of the method.
The authors present their own experience in the treatment of tuberculum sellae meningiomas. The presented series includes 14 patients operated on during past 7 years. Visual loss was the first symptom in 78% of patients. The period between the onset of symptom and surgical treatment was long and in the majority of patients exceeded 2 years. Monocular blindness was found in 71% of cases prior to surgery. The authors present the results of surgical treatment with special attention directed to visual function after surgery. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. When the size of tumour exceeds 4 cm and compressing of adjacent important neurovascular structures is evident, possibilities of total removal are limited and the chance for visual improvement is low.
The aviator's antigravity suit (G-suit) was used for 40 operations on neurosurgical patients operated on in sitting position. The G-suit was filled with air to 0.2 atmosphere (20 kPa) pressure in 26 cases, and 0.3 atm. (30 kPa) in 14 cases. In all cases G-suit filling was followed by central venous pressure rise and mean arterial pressure rise. Venous air embolism was found in 5 (12.5%) patients. No other complications connected with the use of G-suit were observed.
The authors present some clinical aspects of their own experience in the operative treatment of clinoidal and en-plaque suprasellar meningiomas which account for 5.6% of all intracranial meningiomas in Department of Neurosurgery treated in the years 1987-93. Visual loss was the first symptom of disease. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. Possibilities of total removal are limited by the size of tumour and compression of adjacent structures, and the chance for visual improvement is low for that reasons. Visual improvement was observed in only one case after surgery, however in 5 cases worsening of visual acuity was noted in postoperative period. Mortality rate was 6.2%. Adjuvant radiotherapy was performed in non patient. Long term results in ophthalmological and neurological aspects are discussed.