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Ostrava, Czech Republic

Hovorka J.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2010

In this paper we provide an overview of the basic principles of the treatment of epilepsy. These include attention to certain key points: making a correct diagnosis; the risk of seizure recurrence; the decision to initiate drug therapy in newly-diagnosed epilepsy; drug choice in relation to seizure/syndrome type and individual patient characteristics; treatment strategy in terms of monotherapy or of combination therapy; the treatment of pharmaco-resistant epilepsy, and finally the decision to withdraw antiepileptic drug(s) from seizure-free patients. Source

Smrcka M.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2011

Head injury is defined as severe in patients with a post-resuscitation Glasgow coma scale (GCS) figure of ≤8. Such patients are relatively deeply unconscious and cannot follow instructions. Therefore we need continuously to monitor those parameters that provide us with important information regarding patient condition and brain function. In recent years, the possibility of monitoring certain cerebral and intracranial function parameters has been added to the routine intensive care watch repertoire of pulse oxymetry, blood pressure, body temperature, laboratory monitoring, central venous pressure, fluid balance, end-tidal CO2, etc. Monitoring of neurological status, particularly the level of consciousness (GCS) and the pupils is obvious. In terms of invasive intracranial monitoring it is currently practically mandatory that intracranial pressure (ICP) be monitored, either by means of external ventricular drainage or by intraparenchymal probe. As well as this, we monitor cerebral perfusion pressure (CPP). Monitoring of brain tissue oxymetry (PtiO2) is becoming a standard modality, while microdialysis is also frequent in some departments. CT monitoring is very important to the clinician, particularly in the initial phases after the injury, mainly as an indication for decision-making in certain operative procedures. Individual approaches to multimodal monitoring have to be evaluated in relationship to one another and the patient. Special types of software help us to evaluate the indices of vascular reactivity and this knowledge is currently used to establish the optimal CPP for the individual patient. Monitoring of cerebral physiology should not be purposeless, but should serve for early diagnostics of pathological conditions and at the same time may indicate a correctly performed therapeutical intervention. Source

Vaverka M.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2012

Objective: The author's experience with more than 2,200 open surgical releases of carpal tunnel syndrome with no serious complications are presented and compared with modern endoscopic methods. Patients and methods: Over 13 years, one surgeon had operated all patients using the same surgical technique. Patients from the last two years were followed-up prospectively, evaluating anatomical variants and all kinds of complications. Results: In 221 patients 299 surgeries were performed, 89 on the right side, 54 on the left and 78 on both hands (35.3%). Surprisingly positive results were also achieved in a subgroup of 87 seniors over 65 yrs. There was no injury to the median nerve or branches, postoperative hematoma or infection was not present. An important surgical variant was identified in 3 cases (1%), a minor anatomical change in 10%. Reoperation for scarring was needed in two cases (0.7%), with good final results. After 6 months, grip dysfunction and pillar syndrome were present in 1% of cases only, tendovaginitis of flexor pollicis longus was also treated in 1%. Conclusion: Open surgical approach - mini-open technique - still offers excellent results with minimal number of complications and minimal financial expenses. Source

Mracek J.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2016

The fundamental idea behind decompressive craniectomy (DC) is a surgical solution to the conflict of an increasing intracranial content within the fixed-volume intracranial cavity. The expanding intracranial content is caused by brain edema caused by a variety of pathologies. In spite of DC renaissance over the recent years and some evidence of its effectiveness, its use is not yet generally accepted. Traumatic brain injury is by far the most frequent indication for DC. However, the evidence of its effectiveness is limited. Data on the role of secondary decompression in patients with refractory intracranial hypertension after conservative treatment failure are expected to be released soon. Bifrontal early DC is not superior to medical management in patients with diffuse traumatic injury. Primary decompression in patients with acute subdural haematoma has been investigated in a randomized trial. The most conclusive evidence is in patients with malignant middle cerebral artery infarction. In spite of this, the surgery is still underutilized and the frequency of its use does not correspond with the incidence of malignant infarction. When decompression is performed within 48 hours of stroke onset in patients younger than 60 years, it reduces mortality and improves functional outcome. DC is also a lifesaving procedure in patients over 60 years of age for whom it improves chances of survival without total dependency. Decompression should be considered in patients with cerebral venous thrombosis that causes intractable intracranial hypertension. Furthermore, patients with bilateral mydriasis can also profit from the procedure. DC with or without hematoma evacuation might reduce mortality in patients with large supratento- rial intracerebral hemorrhage who are in coma or have refractory intracranial hypertension. Even though the DC can be effective in selected subgroups of patients with subarachnoid hemorrhage, current guidelines, do not specify the role of decompression in these patients. Source

Vybihal V.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2014

Hydrocephalus is a disease developing as a result of failure in production, circulation or resorption of the cerebrospinal fluid. It develops due to congenital or acquired causes, including bleeding, inflammation, injury or tumour. Clinical symptoms depend on age, type and speed of development of hydrocephalus. Computed tomography, magnetic resonance and ultrasound in children with open anterior fontanel are used to diagnose hydrocephalus. Surgical therapy is a gold standard for the treatment of hydrocephalus. Shunt surgeries are performed more frequently than other types of surgical interventions. Ventriculoperitoneal shunts are preferred due to less serious complications that are easy to repair. Ventriculoatrial shunts are implanted when it is not possible to drain cerebrospinal fluid into the abdominal cavity. The need for multiple surgical revisions makes shunt surgery difficult. Endoscopic operations have a low complication rate and do not require implantation of a foreign material. However, endoscopic operations are not suitable in all types of hydrocephalus. They are mainly indicated in obstructive hydrocephalus, although they can also be used in some types of communicating hydrocephalus. In these instances, however, success rate is lower. Source

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