[Operative treatment of syringomyelia].

There are many methods applied in operative treatment of syringomyelia. They may be divided into three groups: suboccipital decompression, myelotomy with drainage of the syringomyelic cavity, and terminal ventriculostomy. Occipito-vertebral decompression is the treatment of choice in cases of coexisting abnormalities in the region of the occipital foramen.

[Diagnostics of syringomyelia coexisting with Arnold-Chiari syndrome].

Frequent coexistence of syringomyelia and Arnold-Chiari syndrome results in overlapping of symptoms caused by these processes. Because the most common location of syringomyelic cavities is in the cervico-thoracic part of the spine, the first symptoms usually concern the upper extremities. Symptoms induced by compression through the invaginated cerebellar tonsils to the occipital foramen in Arnold-Chiari syndrome may be divided into three groups: increased intracranial pressure, cerebellar and spinal symptoms.

[Syringomyelia and Arnold-Chiari syndrome].

Many hypotheses concerning pathogenesis of syringomyelia were abandoned because of evidence found in more recent investigations. We should rank among them the "classical" theories of Gardner and Williams based on the assumption that syringomyelic cavities result from directing the fluid from the fourth ventricle to the central canal of the spine in the case of disturbances of circulation of the cerebrospinal fluid in the region of the cranio-spinal junction. The theory of intraspinal pulsation pressure of Greitz may explain the pathogenesis of syringomyelia in the case of obstacles to fluid flow from the cranial cavity to the spinal canal as in patients with Arnold-Chiari syndrome.

[Pathogenesis of syringomyelia].

Formation of syringomyelic cavities may be caused by known pathologic processes, e.g. neoplastic tumours, arachnitis, traumas or malformations of the cranio-vertebral junction, while pathogenesis of idiopathic, primary syringomyelia has not been established so far.

Clinical signs pointing to the source of hemorrhage in multiple intracranial aneurysms.

Background: In multiple aneurysms of cerebral vessels it is essential to correctly identify the aneurysm that has caused the hemorrhage, since it must be operated first. On the basis of our own material, we have evaluated the usefulness of various clinical signs and examinations in diagnosing which of several aneurysms was the cause of an intracranial hemorrhage.

Material/methods: The material consisted of 163 patients with a total of 391 aneurysms.

[Resumption of professional work after cerebral aneurysm surgery].

The influence of various factors upon the resumption of professional work was examined in the group of 87 patients, who had undergone an operation of single cerebral aneurysms. Professional activity was resumed by 59.9% members of the examined group.

[Management in cases of multiple cerebral aneurysms].

In the management of multiple intracranial aneurysms one has to face some problems, which do not occur in cases with single ones. The majority of neurosurgeons nowadays trend to operate on all detected aneurysms. Some controversy still exists concerning operating strategy--to operate all aneurysms simultaneously or in stages.

[Spontaneous intracerebral hematomas].

The choice of treatment in spontaneous intracerebral haematomas has always been controversial. As indications to surgery should be regarded: location and size of haematoma, shifting of midline structures and deterioration of consciousness. The results of treatment are worsened by deep location of haematoma, especially in thalamus and brain stem region, very big size, primary serious condition, very advanced age of the patient and some metabolic diseases like liver dysfunction.

[Theories of intracranial aneurysm etiology].

The main theories of the origin of intracranial aneurysms as the most common vascular malformations are presented. Three main theories maintain that they are either the congenital, acquire or both of those defects. The presence of aneurysms in the bifurcations of the arteries with the loss of the muscle layer and the coexistence with other vascular malformations of the arteries and their rareness in children give the evidence of the acquire origin.

[Biological and clinical significance of acute phase proteins with particular emphasis on the role of C-reactive protein].

The acute phase response is a non-specific, early phenomenon, in which the concentration of a number of plasma proteins is increased following most forms of tissue injury, bacterial infection, inflammation, malignant neoplasia and surgical procedures. These plasma proteins are collectively termed acute-phase proteins. Their most important role is to restore the homeostasis of human organism.

[Spontaneous intracerebral hematomas in the material of the Department of Neurosurgery of Medical Academy in Lublin].

Between 1972 and 1991, 170 patients with spontaneous nontraumatic intracerebral haematomas were treated in the Neurosurgical Department of Medical Academy in Lublin. In 89 (52.5%) patients, the haematomas were caused by ruptured aneurysms; in 14 (8%), by angiomas; 67 (39.

[Direct effects of the intrathecal administration of normal saline for the brain expansion after the removal of subdural hematoma].

In a group of 360 patients the effects were studied of various management methods in case of lacking expansion of the brain after removal of chronic subdural haematoma on the therapeutic results. It was found that intrathecal infusion of normal saline was an effective procedure, with small frequency of transient complications, and was followed by a considerably lower number of re-operations than after external or internal drainage of haematoma cavity.

[A case of multiple vascular malformations of brain and liver].

In a woman aged 45 years after a generalized epileptic seizure CT and MRI demonstrated a lesion of the type of vascular malformation of the brain diagnosed as a haemangioma by angiography which demonstrated also presence of an aneurysm of the left pericallosal artery. Abdominal ultrasonography and tomography found also hepatic haemangioma. Both cerebral vascular lesions were managed successfully in one-step operation.

[Spontaneous acute subdural hematoma].

A rare case of spontaneous acute subdural haematoma is reported. Causes of non-traumatic subdural haematomas are discussed stressing the necessity of rapid surgical intervention.

[Vasoactive neuropeptides CGRP (calcitonin gene-related peptide) and vasospasm during subarachnoid hemorrhage from ruptured intracranial aneurysm].

The authors discuss the role of active neuropeptides Calcitonin Gene-Related Peptide (CGRP) and Vasoactive Intestinal Polypeptide (VIP) in the arterial spasm caused by haemorrhage from ruptured intracranial aneurysm. These substances act as vasodilators on brain vessels. Between the first and the second week after subarachnoid haemorrhage their concentration in the periarterial nerve fibres of the big vessels is significantly low.

[Familial occurrence of intracranial aneurysms].

Four cases of intracranial aneurysms are reported found in two families. They accounted for 1% of all patients with these aneurysms treated in that time period. The aetiology of the aneurysms, the most frequent locations in familial cases and the risk of occurrence of asymptomatic aneurysms in such families are discussed.

[Aneurysm of the azygos anterior cerebral artery].

A case of aneurysm associated with the anterior cerebral artery is described. The authors stress diagnostic difficulties in such cases and discuss the coexistence of vascular anomalies and cerebral aneurysms.

[Brain abscesses of unknown etiology].

On the basis of literature data and own material of 18 cases of cerebral abscesses of unknown origin the authors discuss their incidence, most frequent locations, diagnostic difficulties and results of surgical treatment in relation to remaining groups of cerebral abscesses of known aetiology.

[Evaluation of cerebral blood flow in postoperative increased intracranial pressure].

In 20 patients with expanding intracranial lesions the intracranial pressure, cerebral blood flow, mean arterial blood pressure were determined and the cerebral perfusing pressure and cerebral vascular resistance were calculated before the operation and after removal of the expanding lesion. In 7 cases rises of the intracranial pressure occurred after the operation. In 5 of them they were associated with increased cerebral blood flow and decreased vascular cerebral resistance which was an evidence of their vasogenous mechanism.

[Relation between cerebral blood flow and the changes in perfusion pressure in patients with brain compression processes].

In 20 patients with expanding intracranial lesions the cerebral blood flow was determined by the method of Kety-Schmidt in an own modification with an original device--N2O-meter, with simultaneous continuous measurement of the intraventricular pressure and arterial blood pressure. This made possible determination of the cerebral perfusion pressure and of the effect of its fluctuations on the cerebral blood flow. Lowering of the cerebral blood flow below the normal value occurred when the perfusion pressure fell below 60 mm Hg, but its further fall, even to 20 mm Hg, caused no proportional decrease of the cerebral blood flow.