A prospective study was carried out at the Zagreb University Hospital Centre to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and quality of life (QoL) in patients with ...epilepsy (PE), and its association with depressive symptoms and sexual dysfunction (SD). QoL was assessed by use of the Quality of Life in Epilepsy-31 Inventory (QOLIE-31), SD by the Arizona Sexual Experiences Scale (ASEX), and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D17). The study included 108 PE (women 63% and men 37% men), mean age 39.54±15.91 years. Focal type epilepsy was diagnosed in 14.8%, generalized type in 35.2%, and both types were present in 40.7% of study patients. Drug-resistant epilepsy (DRE) was present in 44/108 and vagus nerve stimulation (VNS) was implanted in 27/44 patients. The mean response on QOLIE-31 was 62.88±17.21 with no significant differences according to gender, type of epilepsy, and age. A statistically significantly lower QoL was found in the ‘Overall QoL’ domain (35-55
vs
. <35 age group). Patients taking both types of AEDs had a significantly lower QoL compared to those on newer types of AEDs. Higher QoL was associated with less pronounced depressive symptoms (p=0.000). Significant correlations were found between lower QoL and SD (p=0.001). In 27 patients with DRE having undergone VNS, a favorable effect of VNS implantation on the QoL and mood was observed as compared with 18 patients without VNS (p=0.041).
In 1998, a teleradiology system was established in Croatia. It connects 34 CT, MRI and DSA scanners in 29 hospitals with a referral centre in the neurosurgery department in Zagreb. In the first three ...years of its use, the network saved more than 400,000 km of patient transportation (i.e. without a teleconsultation, all of the patients would have had to be transported to the nearest referral neurosurgical unit). During the first seven years, an archive with 25,366 expert opinions was collected. A total of 7103 (28%) expert opinions were provided for the distant regional hospitals. The most common diagnoses for patients from regional hospitals were neurotrauma (53%), cerebrovascular diseases (22%) and brain tumours (19%). The teleradiology system was used less often for lumbar disc disease (4%), hydrocephalus or other neurosurgical disorders (2%). The most valuable results from teleradiology were the decisions about proper and effective patient treatment. In Croatia, the national teleradiology network for neurosurgery has speeded up therapy, avoided unnecessary travelling for patients and reduced costs.
Provedeno je prospektivno istraživanje u KBC-u Zagreb s ciljem procjene povezanosti epilepsije, antiepileptičkih lijekova
(antiepileptic drug, AED) i kvalitete života (quality of life, QoL) u ...bolesnika s epilepsijom, kao i učestalosti depresije i
seksualne disfunkcije (SD). QOLIE-31 (Quality of Life in Epilepsy-31 Inventory) je primijenjen za procjenu QoL-a, ASEX
(Arizona Sexual Experiences Scale) za SD i HAM-D17 (Hamilton Rating Scale) za depresiju. Uključeno je 108 bolesnika s
epilepsijom (63% žena, 37% muškaraca; srednja dob 39,54±15,91 godina). Žarišnu epilepsiju imalo je 14,8% i generaliziranu
35,2% bolesnika, dok je obje vrste epilepsije imalo 40,7% bolesnika. Farmakorezistentnu epilepsiju (drug-resistant epilepsy,
DRE) imalo je 44/108 bolesnika, a kod njih 27/44 ugrađen je stimulator vagusnog živca (vagus nerve stimulation, VNS).
Srednji odgovor na QOLIE-31 bio je 62,88±7,21 bez značajnih razlika u odnosu na spol, vrstu epilepsije i dob. Statistički
značajno niži QoL nađen je u domeni ‘Sveukupni QoL’ (dobna skupina 35-55 godina u odnosu na dobnu skupinu <35).
Bolesnici koji su uzimali obje vrste AED imali su značajno niži QoL u usporedbi s onima na novijim AED. Viši QoL bio je
povezan s manje izraženim simptomima depresije (p=0,000). Pronađene su značajne korelacije između nižeg QoL-a i SD
(p=0,001). U bolesnika s DRE utvrđen je pozitivan utjecaj ugradnje VNS-a na QoL i raspoloženje (27 bolesnika s VNS-om
u usporedbi s 18 bolesnika bez VNS-a, p=0,041).
Introduction:
Skull base tumors that originate or extend into parasellar area are challenging lesions due to the fact that they often surrounds vital nerves and vessels. To protect them each case ...should be analyzed meticulously and the best approach chosen accordingly. Despite the evolution of refined microsurgical instrumentation and techniques and shift toward minimal invasive approaches complex tumors requires more than straightforward approach. We report our experience and analyze the effectiveness of different approaches for safe and complete removal of anterior fossa and parasellar meningiomas.
Material and Methods:
We analyzed our series of patients operated for anterior skull base meningiomas, or meningiomas that extends into sellar and parasellar region via different approaches. Clinical and radiology parameters, tumor location and size, extent of surgical resection, pre- and postoperative results are presented and discussed. We report the technical nuances of the procedures based on our experience which are of fundamental value for the safety and efficacy in applying those approaches.
Results:
As most of the meningiomas are approachable with pterional approach, in some of tumor locations other approaches are selected as better options regarding invasiveness, complication rate and safety. Huge numbers of meningiomas were treated through keyhole craniotomy, but other approaches gives different perspectives and easier protection to vital structures. Although radical surgery to at least Simpson 2 grade was achieved, new technology as gamma knife surgery is an adjunct which can reduce the morbidity and mortality.
Conclusion:
Different approaches are available for skull base meningiomas and the selection of the approaches depend on the location, tumor spread, surrounding of vital structures and size of tumors. The supraorbital eyebrow keyhole approach had been adopted in our institution in 1996 and has since been developed and refined so that today it represents the common route in addressing various pathology of anterior circulation and anterior fossa and parasellar tumors, but other approaches are used in tumors that spread out of selected area of anterior skull base fossa, especially where there is a chance to provide better functional results and better protection of vital structures as nerves and vessels.
Abstract Concussion is the most common type of traumatic brain injury, with headache being the most frequent symptom of mild traumatic brain injury (MTBI) (including dizziness, vomiting, nausea, lack ...of motor coordination or difficulty balancing). Concussion may be caused by a blow to the head, or by acceleration forces without a direct impact. Often, MTBI occurs as the result of a sports injury. Loss of consciousness is always present, unlike vomiting. Therefore, we hypothesize vomiting to be considered as a cardinal sign of concussion. Stimulation of vomiting centres finally triggers vomiting. Professional boxers and mixed martial arts competitions reluctantly agree with stringent rules and protective clothing. We discuss the issue of further protection for those engaged in these and other sports.
Abstract Physicians occasionally encounter the punch-drunk syndrome among boxers after longlasting careers characterized by blows to the head. The list of sports leading to punch-drunk syndrome is ...rapidly increasing, making it a notable public health problem. A lack of specific findings leads to defects in reporting the condition, and consequently to delay in treatment. Although the rigorous enforcement of sport rules and constant improvements of sporting equipment have decreased the occurrence of the syndrome, early detection of punch-drunk syndrome is crucial and would have comprehensive benefits. Two groups of signs and symptoms can be identified: dementia and Parkinsonism. A prompt diagnosis with a correct classification of the suspected cases is crucial. Therefore, we offer an overview of the symptomatology as well as proposing the introduction of a screening method among risk groups based on generic and minute neurological examination and dementia testing.
Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients older than 12 years was approved in Europe in 1994 and in ...the United States in 1997. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Centre Zagreb. From 1997 to 2001 we have implanted VNS in 11 patients with pharmacoresistant epilepsy, who were magnetic resonance imaging (MRI) negative and from May 2007 to May 2009 in 11 patients with pharmacoresistant epilepsy, 9 of them were MRI positive, and were inoperable due to localisation of the pathomorphologic changes (ganglioglioma, hamartoma, various types of cortical dysplasia, porencephalic cysts), 2 were MR negative. In the group of MRI negative patients 1 patient had complex partial seizures (CPS), 6 patients had CPS with secondary generalisation, 2 patients had primary generalized epilepsy (PGE) including myoclonic, absence, atonic and tonic-clonic seizures, one patient had PGE and CPS, and 3 patients had Lennox-Gastaut syndrome (LGS). In the group of MRI positive patients one patient had elementary partial seizures (EPS) and CPS, two patients had EPS and CPS with secondary generalisation, one patient had CPS, 3 patients had CPS with secondary generalisation, and 2 patients had CPS with secondary generalisation as well as atonic seizures. After continuous follow-up of 11 MRI negative patients during 5 years and 2 MRI negative patients during one year there was decrease in mean-seizure frequency of 51.67%. After continuous follow-up of 9 MRI positive patients during 2 years there was decrease in mean-seizure frequency of 61.9%. The most frequent side effects were hoarseness, throat pain and cough in the "on phase" of the VNS, but they were mild and transitory. We can conclude that VNS was effective mode of therapy in our group of patients with pharmacoresistant epilepsy.
Objectives:
We aim to describe our experience in the last 10 years concerning the surgery of sellar and parasellar tumors using three minimally invasive procedures (“keyhole,” trans-sphenoidal, and ...endoscopic).
Introduction:
Minimally invasive neurosurgery implies gentle manipulation during a microsurgical approach, with no traumatization at the target point. According to these postulates we perform three different approaches.
Materials and Methods:
In the last 10 years, we performed a total of 507 neurosurgical procedures in patients with sellar region tumors, 314 trans-sphenoidally (16 “pure” endoscopic since 2004) and 193 using supraorbital minimal craniotomy with skin incision in the eyebrow. The surgical approach was determined by tumor placement and characterized using CT and MRI scans.
Results:
Pathology approached via “keyhole” craniotomies amounted to 69 meningiomas, 59 adenomas, 28 craniopharyngiomas, and 37 other lesions. Trans-sphenoidally we performed surgery on mostly adenomas and 34 other lesions. There were 56% females and 44% males, aged 18 to 75 years. Postoperative complications included CSF leakage (9%); visual impairment (12%); infection (7%); and 6.7% frontal branch of facial nerve palsy.
Conclusion:
According to neuroradiological findings, for tumors of the sellar region (mostly adenomas) we perform trans-sphenoidal or a “pure” endoscopic procedure; in the parasellar region we mostly use a supraorbital “keyhole” approach which is appropriate to approach almost all sellar and parasellar tumors.
Intrasellar arachnoid cysts are rare conditions. Two cases of a large symptomatic intrasellar arachnoid cyst with a suprasellar extension are reported. A 62-year-old woman was admitted with signs of ...panhypopituitary syndrome with gonadotropin/growth hormone insufficiency. MR findings showed suspected cystic tumor in the sellar region. Transsphenoidal surgery was performed in a microsurgical manner with endoscopic assistance. Intrasellar finding was a septal cyst filled by CSF-like fluid without communication with the suprasellar cisterns.The cyst was opened, decompressed, and removed completely.
A 28-year-old woman was admitted because of decreased visual acuity, signs of increased intracranial pressure, memory impairment, and menstrual irregularity. Endocrinological hormone evaluation showed hormone levels to be normal except for the slightly elevated PRL. Visual field evaluation was mildly narrowed on both sides with a superotemporal depression. Magnetic resonance imaging showed a large intrasellar cyst with suprasellar extension and compression of chiasm and the anterior part of the third ventricle. A pure endoscopic transsphenoidal operation was performed and arachnoid cyst was found in the intrasellar and suprasellar spaces. Cyst fenestration was carried out with excision of the membranous part of the cyst. Postoperative MRI 2 months after the operation showed sellar obstruction without signs of recurrent cyst.
Histological analysis in both cases revealed that the cyst wall was composed of connective tissue and arachnoid cells, which were ultrastructurally characterized by a number of desmosomes.
In cases of symptomatic intrasellar cysts we must think not only about cystic tumors but also about arachnoid cyst. Transsphenoidal surgery is recommended in cases with sellar obstruction.
