Mycoplasma infections in freshwater carnivorous fishes in Hungary

The abundance of mycoplasma-like microorganisms seems to be common in the intestinal tract of fish, but their occurrence in other organs can be considered pathological. Isolation of piscine mycoplasmas is essential to prove their virulence. In this study, a total of 100 specimens of nine freshwater fish species collected from natural waters and fish farms were analysed for the prevalence of mycoplasmas in different extraintestinal organs. Our results demonstrate that mycoplasmas are present in carnivorous fish (pike, wels catfish, black bullhead and pike perch) than in cyprinids more frequently. Among the surveyed organs, they colonize mainly the gills, the kidney and the livers. Although mycoplasmas could be detected in one-fifth of samples by molecular assays, the isolation of mycoplasmas belonged to the M. sualvi cluster within the hominis group of Mycoplasmataceae, but was separate from M. mobile, has been successful only from some specimens originated from wels catfish that was feasible only by special preparation steps (prefreezing, filter sterilization and incubation conditions (long culturing period, etc.). The low-efficiency of isolation trials indicates an extensive gap in our knowledge about piscine mycoplasmas, especially in the field of their nutritional requirements.

Histopathological changes on the gills of asp (Aspius aspius) and European catfish (Silurus glanis) caused by Lamproglena pulchella and a Lamproglena sp. (Copepoda: Lernaeidae), respectively

In a parasitology survey of Hungarian fishes, heavy infections of parasitic copepods Lamproglena pulchella and a Lamproglena sp. were found in the gills of the asp and the European catfish, respectively. Individuals of both fish species were emaciated and infected with hundreds of Lamproglena. Copepods located close to the tip of gill filaments and formed a depression at the attachment sites. In histological sections, cell degenerations and local haemorrhages were present adjacent to the maxillipeds and where the maxillary claws pierced the gill tissue. Around maxillae and in the midgut of the Lamproglena, damaged piscine blood cells and remains of the gill tissue were observed. Host reaction was expressed by proliferation of epithelioid cells, increase in both number and size of goblet and mast cells and formation of giant cells.

New record of metacercariae of the North American Posthodiplostomum centrarchi (Digenea, Diplostomidae) in pumpkinseed (Lepomis gibbosus) in Hungary

Two species of the genus Posthodiplostomum (Digenea: Diplostomatidae) (Posthodiplostomum brevicaudatum Nordmann, 1832 and Posthodiplostomum cuticola Nordmann, 1832) are known as parasites of Hungarian native fishes. Metacercariae of P. cuticola are widespread in Europe and cause black spot disease. Several species of Posthodiplostomum were described also from North America but none of them has been isolated in Hungary up to now. Posthodiplostomum centrarchi Hoffman, 1958 has been detected recently in pumpkinseeds (Lepomis gibbosus L., 1758) in several European countries. Posthodiplostomum centrarchi was isolated for the first time in Hungary from pumpkinseeds caught in the Maconka water reservoir in 2015. Thereafter, several natural waters (e.g. the River Danube, Lake Balaton and the Sió channel) were sampled in order to determine its presence and distribution. Only the native species P. cuticola was detected in Lake Balaton on cyprinids but a relatively high infection rate of P. centrarchi was observed in the Sió channel close to the lake. Pathological changes were absent, and metacercariae were mostly attached to the surface of the liver, kidney and heart. The phylogenetic analysis of the ITS and COI sequences of P. centrarchi and P. cuticola clustered into two distinct branches, which was in agreement with the morphological results.

Facile and scalable synthesis of sub-micrometer electrolyte particles for solid acid fuel cells

Nanostructuring fuel cell electrodes is a viable pathway to reach high performance with low catalyst loadings. Thus, in solid acid fuel cells, small CsH₂PO₄ electrolyte particles are needed for the composite powder electrodes as well as for thin electrolyte membranes. Previous efforts have resulted in significant improvements in performance when using sub-micrometer CsH₂PO₄ particles, but laborious methods with low throughput were employed for their synthesis. In this work, we present a simple, robust, and scalable method to synthesize CsH₂PO₄ particles with diameters down to below 200 nm. The method involves precipitating CsH₂PO₄ by mixing precursor solutions in alcohol in the presence of a dispersing additive. The influence of the concentrations, the batch size, the solvent, and the mixing process is investigated. The particle size decreases down to 119 nm with increasing amount of dispersing additive. Mixing in a microreactor leads to a narrower particle size distribution. The particle shape can be tuned by varying the solvent. The ionic conductivity under solid acid fuel cell conditions is 2.0 × 10^-2 S cm^-1 and thus close to that of CsH₂PO₄ without dispersing additive.

Cross section of gill filaments in histological preparations helps better identification of the location of myxosporean plasmodia in gill tissues

Location and tissue preference of filamental-type myxosporean plasmodia in histological slides of the gills can be properly identified only in cross sections of the gill filaments. The authors selected three myxosporeans (Myxobolus rutili, M. dispar and Henneguya psorospermica, parasites of the roach, the common carp and the pike, respectively) for studying the problem. The plasmodia of these species studied in longitudinal sections were earlier regarded as developing inside the filamental arteries. Cross sections of the filaments showed that all the three species developed plasmodia in the dense connective tissue constituting the adventitia of gill arteries and covering the cartilaginous gill rays. Myxobolus rutili started its development close to the afferent branchial artery but attached to the cartilaginous gill ray. More developed plasmodia of this species surrounded the rays. Plasmodia of M. dispar were formed on the inner side of the afferent branchial artery, while those of H. psorospermica were located at the external side of the efferent branchial artery.

Molecular genetic investigations on Balantidium ctenopharyngodoni Chen, 1955, a parasite of the grass carp (Ctenopharyngodon idella)

Balantidium ctenopharyngodoni is a common ciliate in Hungary, infecting the hindgut of grass carp (Ctenopharyngodon idella), a cyprinid fish of Chinese origin. Although data have already been presented on its occasional pathogenic effect on the endothelium of the host, generally it is a harmless inhabitant of the gut. Phylogenetic analysis of the 18S rDNA and ITS fragments of this protozoan proved that it is in the closest phylogenetic relationship with endocommensalist and symbiont ciliates of mammals feeding on large volumes of green forage, in a similar way as Balantidium spp. known from algae-eating marine fishes.

Digenean trematodes in Hungarian freshwater aquacultures

Occurrence of metacercariae of potentially zoonotic trematodes (Platyhelminthes: Digenea) in the musculature of common carp (Cyprinus carpio L. 1758) was monitored in four Hungarian aquacultures. Four geographically distinct fish farms (located in the Northwestern, Southwestern, Northeastern and Southeastern parts of Hungary) were selected for the investigation. From each farm, a total of 258 one-summer-old fingerlings were sampled and examined in the years 2016 and 2017. In addition, in 2017, we examined 60 market size specimens (30 two-summers and 30 three-summers) sampled from the most infected aquaculture in the Northeastern part of Hungary. The fish were euthanized and decapitated whereafter their musculature (fillets) was digested in a pepsin solution to isolate metacercariae from the tissue whereafter morphological and molecular analyses (PCR and sequencing of ITS region) were performed. Opisthorchiid metacercariae were not recovered but in one of the farms numerous metacercariae were detected in the musculature of carp. They were identified as cyathocotylid trematodes based on their morphological characteristics and by sequencing the ITS region. The infection levels proved to be remarkably different among the four fish farms. Carps from the Northeastern farm were infected by large numbers of cyathocotylid metacercariae, while 8 Posthodiplostomum cuticola metacercariae were detected in the Northwestern aquaculture. In the other two farms (Southwestern and Southeastern) no infection was recorded. The infected farm is located close to a protected natural wetland habitat populated by a rich fauna of aquatic birds (potential final hosts) and snails (first intermediate host) which may create a higher risk of infection in the neighbouring fish farms.

Molecular evidence of the absence of Metagonimus yokogawai (Katsurada, 1912) in Europe: report of Metagonimus sp. in cyprinoid fish from the River Danube in Hungary

Trematodes of the genus Metagonimus Katsurada, 1912 (Digenea: Heterophyidae) are zoonotic parasites that cause infections in humans, with most cases reported in Southeast Asia. Larvae from the second intermediate host, called metacercariae, of one of human-infecting species, M. yokogawai (Katsurada, 1912), have been reported from cyprinoid fish in Europe. In the present study, we provided DNA-based evidence that metacercariae of Metagonimus, which are commonly found in the scales of various cyprinoids in Central Europe (Danube River in Hungary) do not belong to M. yokogawai. Sequence analysis of the ITS region, 28S rDNA, and cox1 genes showed that this species is clearly distinct from all Asian species, including M. yokogawai, which probably does not occur in Europe. Metacercariae from cyprinoids might belong to Metagonimus romanicus (Ciurea, 1915), an insufficiently known species described from Romania.

Infection of the Carpathian brook lamprey (Eudontomyzon danfordi Regan, 1911) with a dermocystid parasite in the Tisza River Basin, Hungary

The Carpathian brook lamprey (Eudontomyzon danfordi Regan, 1911) is an endemic protected species of Cephalaspidomorphi in the Carpathian Basin. No parasites have become known from these jawless vertebrates to date. Here, the authors describe an infection from a single specimen manifesting in protuberant skin cysts 7-10 mm in diameter, scattered on the body surface. Similar dermal infection was observed in 25 of the 274 lampreys recorded in the population survey. Skin cysts filled with round spore-like structures of a dermocystid parasite were found. These particles measured 8-14 µm in diameter and had an about 0.5 µm thick wall, and containing mainly a granular mass and a relatively scarce plasma. No hyphae were recorded. Despite conspicuous morphological changes in the skin, no inflammatory reactions were found. The molecular analysis of 18S rDNA showed similarity to dermocystid species of several fish species but differed from them approximately by 2%. This is the first record of a dermocystid parasite infecting a jawless vertebrate.

Identification of a novel HLA-B allele, HLA-B*08:177, in a Hungarian patient and her HLA identical sibling

The newly detected HLA-B*08:177 differs from HLA-B*08:01:01:01 by 1 single nucleotide substitution at position 365 of exon 3.

Molecular detection of a novel cyprinid herpesvirus in roach (Rutilus rutilus) and asp (Leuciscus aspius) showing typical signs of carp pox disease

In the early spring of 2018, in Lake Balaton (Hungary), a roach (Rutilus rutilus) and an asp (Leuciscus aspius) were found in an fish trap at the outlet of the river Sió showing typical signs of the so-called carp pox disease, such as foci of epidermal hyperplasia on the head and the whole body surface, including the fins. Molecular tests revealed the presence of the DNA of an unknown fish herpesvirus. Three genes encoding the DNA-dependent DNA polymerase, major capsid protein and ATPase subunit of terminase were amplified and sequenced from the alloherpesviral genome. The gene sequences of the viruses obtained from the two different fish species shared 94.4% nucleotide sequence identity (98.1% amino acid sequence identity), suggesting that they belong to the same virus species. Phylogenetic analysis based on the DNA polymerase (and the concatenated sequences of the amplified genes, as well) implied that the detected virus belongs to the genus Cyprinivirus within the family Alloherpesviridae. The sequences of the novel alloherpesvirus diverge from those of the five cyprinivirus species described previously, so it putatively represents the sixth virus species in the genus.

Oral Health Status of Kidney Transplant Patients

Drug-induced immunosuppression can predispose kidney transplant patients to different complications including chronic infections and oral lesions. We surveyed oral hygiene habits and conducted detailed periodontal examinations for status assessment. Appropriate oral hygiene and regular professional control can reduce number and severity of complications, which might be preventive for transplant rejection.

Histological investigation on Ancyrocephalus paradoxus (Dactylogyridea: Ancyrocephalidae) infection causing mortalities in an intensively cultured pikeperch [Sander lucioperca (L.)] stock

In a cultured pikeperch (Sander lucioperca) stock the monopisthocotylean monogenean gill parasite Ancyrocephalus paradoxus caused heavy infection and mortalities. The gills of the affected fish specimens were infected by 50 to 800 monogenean parasites. Severe pathological changes were found in areas where the worms attached to the gills. At the attachment sites the haptoral discs of the worms formed a deep depression in the epithelium of the filaments, and the anchors pierced into and fixed themselves to the connective tissue of the cartilaginous gill rays. At these attachment sites red blood cells released from injured capillaries were found among the damaged epithelial cells. Around the hooks, anchors and body sections coming into contact with the gill filaments a proliferative tissue developed in which only a remnant of the damaged lamellae was found. Due to the damage caused by the worms the tips of the heavily infected gill filaments fused, formed clubs and were composed of epitheloid-type regeneration tissue lacking respiratory lamellae. In the basal parts of the filaments, where most of the worms attached to the gill, only denuded filaments deprived of lamellae were observed among the cross-sectioned worms in histological sections.

Interpretation of LDH Values after Kidney Transplantation

Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease in function. Ischemic damage is a benign and transient condition, while acute immune rejection requires immediate therapy. A kidney graft ultrasound may produce a false negative result, and graft biopsy is invasive and slow to return results. Serum lactate dehydrogenase (LDH) is under examination as a possible tool for differential diagnosis between ischemic damage and immune rejection. Herein, we analyze the continuous lab results of four patients in the early post-transplantation period, showing patterns correlating with different clinical outcomes and prognoses. In our experience, a persistent elevated LDH accompanies ischemic damage. Immune rejection was, however, associated with a decrease in LDH. Hemodialysis was not a confounding factor, while packed red blood cell transfusion caused severe diagnostic problems.

[Comparison of the investigation and treatment of acute appendicitis in our surgical department during the pre-pandemic period of COVID-19 and in the III. pandemic wave]

Introduction. Appendicitis is one of the most common causes of acute abdominal surgical indications. WHO declared the SARS-CoV-2 (COVID-19) virus infection a pandemic on the 11.03.2020., affecting all segments of healthcare. Management of the acute cases also faced new challenges as a result of the restrictive measures taken during the pandemic, affecting the population and healthcare providers. In our surgical department, during the medical care of those diagnosed with acute appendicitis, in the absence of uniform professional protocols, we often required individual considerations. In the absence of universal professional guidelines, during the medical care of those who had been diagnosed with acute appendicitis we often required individual considerations in our surgical department. Aim. the comparison of the time elapsed between the onset of the symptoms and the time the patients arrived to our surgical department, the frequency of hospitalisation and the frequency and difference between postoperative complications in patients diagnosed with acute appendicitis during the pre-pandemic period of SARS-CoV-2 and the III. wave of COVID-19. Methods. in our retrospective analysis we included those more than 18-years old patients who were diagnosed with the clinic-radiological picture of acute appendicitis during the pre-pandemic 6 months (16. 09. 2019. – 16. 03. 2020.) and the III. wave of COVID-19 (01. 11. 2020. – 01. 04. 2021.). We compared the length of time between the onset of symptoms and the beginning of hospitalisation, the complexity of appendicitis, the method of surgery used, the duration of hospitalisation and the development of postoperative complications. Statistical significance was examined by t-test and Fischer-test. Results. 64 patients were included, 47 in the pre-pandemic period and 17 in the III. wave of COVID-19. During the pandemic, the number of people diagnosed with acute appendicitis showed a declining trend, however the incidence of complicated appendicitis increased (26% « 35%). In the III. wave of COVID-19, the time between the onset of symptoms and the examination was 27,3 h longer on average (P = 0.275), the hospitalisation was 17.3 h longer (P = 0.412) and the postoperative complications (2.12% « 23.5%) and surgical conversions (0% « 21%) were also significantly different (P = 0.264), but there was no significant correlation in either case. Conclusion. although there was no significant correlation in our analysis, it appears that during the pandemic, patients sought medical attention later and with more severe symptoms, resulting in progression of acute appendicitis.

Juvenile Wels Catfish (Silurus glanis) Display Age-Related Mortality to European Catfish Virus (ECV) under Experimental Conditions

We have limited knowledge about the course of the European catfish virus (ECV) infection in different age groups of wels catfish (Silurus glanis). The results of this study demonstrate that an ECV strain isolated from the brown bullhead (Ameiurus nebulosus) in Hungary could cause devastating losses among juvenile wels catfish. Furthermore, the age-related mortality rate following ECV infection was investigated in three virus challenge experiments at two different virus dosages. Eight-week-old (ca. 3 g), ten-week-old (ca. 8 g), and sixteen-week-old (ca. 55 g) catfish were infected with ECV at 21°C. In the youngest age group, 96% (at a 10⁶ TCID₅₀/mL dosage) and 100% (at 10⁵ TCID₅₀/mL) mortality rates were observed, while these rates were reduced to 56% and 68% in the ten-week-old groups, respectively. The mortality was significantly higher in the virus-exposed groups than in the control ones. In the sixteen-week-old group, 23% mortality was detected at a 10⁵ TCID₅₀/mL concentration of ECV. Here, a significant difference was not found between the exposed and control groups. The performed experiments show that different age groups of wels catfish may have various susceptibility to ECV. These findings draw attention to the importance of the prevention of/protection against virus infections in juvenile (up to 3-month-old) wels catfish in aquaculture.

[Tacrolimus therapy after renal transplantation. Current questions of concentration/dose ratio]

Tacrolimus is an important part of immunosuppressive therapy after solid organ transplantation. The therapeutic range of the drug from the calcineurin inhibitor group is narrow. Adjustment of the blood concentration can be very complicated but to be able to avoid the occurrence of side effects or ineffective immunosuppression it is inevitable. This article summarizes the properties of tacrolimus pharmacokinetics, pharmacogenetics and pharmacodynamics. We will focus on individual variations of cytochrome enzymes. In the following part, a new method for screening high risk patients will be introduced. We will present the publications of the determination of the concentration/dose (C/D) ratio. By determining the C/D ratio, researchers identify fast and slow metabolizing patient groups. Fast metabolizers require higher doses in general and the occurrence of complications is also more frequent in this group. Long-term results are lagging behind the slow metabolizing group. The long-term results of renal transplantation nowadays contribute to the postoperative period and the later years rather than the surgery itself. It includes the proper management of previous illnesses (e.g., hypertension, diabetes, endocrinological problems), detection of complications (e.g., infections, malignancies), and the precise regulation of immunosuppressive therapy. Orv Hetil. 2019; 160(30): 1178-1183.

[Our innovations for the reduction of postoperative pancreatic fistula output]

Bevezetés: A posztoperatív pancreasfistula mind proximalis, mind distalis pancreatectomia után a legjelentősebb sebészi szövődménynek számít. A szakirodalomban nincs egyértelműen ajánlott, megbízható módszer ezen probléma kiküszöbölésére, emiatt történnek újítások szerte a világon. Jelen közleményünkben a technikai innovációinkról számolunk be. Anyag és módszerek: 2013. január 1-jétől 2023. november 30-ig terjedő időszakban 205 Whipple-műtétet végeztünk nyitottan, mely során a pancreatojejunalis anastomosist az általunk módosított dohányzacskó-öltéses módszerrel készítettük el. 2019. január 1. és 2023. november 30. között pedig 30 betegnél történt nyitott distalis pancreatectomia, amikor a pancreascsonkot az általunk kifejlesztett technikával, szabad rectus fascia-peritoneum grafttal fedtük, majd azt cirkuláris öltéssel rögzítettük. Közleményünkben ezen két módszerrel elért eredményeket ismertetjük. Eredmények: a demográfiai adatok megfeleltek a betegségnél szokásosnak. A posztoperatív ápolási idő és a transzfúzió igény terén észlelt különbségek tükrözték a kétféle beavatkozás eltérő invazivitását. A releváns pancreasfistula kialakulási rátája kedvező képet mutatott, Whipple-műtét után 7,3% volt, míg distalis pancreatectomát követően nem fejlődött ki. A reoperációs és a halálozási arányok megfeleltek az elvártaknak és korreláltak a műtétek kiterjedtségével. Következtetés: pancreas resectiók utáni komplikációk csökkentésére tett törekvéseink során a módosított dohányzacskó-öltéses pancreatojejunostomia és a pancreascsonk fedésére kidolgozott módszerünk egyaránt kedvező eredményekkel járt.

[The benefits of a hybrid operation room in neurosurgery.]

INTRODUCTION

The hybrid operation room - with a robotic arm equipped angiographic device - started its operation in November 2019 at the Department of Neurosurgery, Szeged, Hungary.

OBJECTIVE

We report the benefits of the hybrid operation room in the neurosurgery practice based on our results and experiences of the last 1.5 years.

METHOD

576 operations took place between 15. 11. 2019 and 01. 03. 2021, which include 332 neurointerventions amd 244 skull-brain and spine surgeries. By using Siemens ARTIS pheno®, we performed purely catheter only interventions or surgical only interventions, but combined treatments were also performed in several cases (catheter and surgical intervention). Thanks to ARTIS pheno® versatility, it is used as a modern imaging system in preoperative examination or as navigation system in spine surgery and control imaging for intra- and postoperative examinations.

DISCUSSION

We created three categories based on the results of the last months according to the need of using the hybrid operation room for the given operation: (1) strongly recommended, (2) recommended, (3) advantageous. Strongly recommended: if the two teams (surgical and interventional team) have to work together during the operation. Recommended: if the two teams are not participating together in the operation, but the other team is on standby and may join the operation if necessary. Advantageous: this category means the possibility of performing control imaging before the wound closure.

CONCLUSION

Based on our experience, the hybrid operation room provides significant help in neurosurgery. It has become part of our daily care, and we think it is indispensable in the work of a neurosurgery center. Orv Hetil. 2023; 164(43): 1701-1711.

Lernaea cf. cyprinacea infection in agile frog (Rana dalmatina) tadpoles in Hungary

The ectoparasitic copepod Lernaea cyprinacea (anchor worm) has more than 100 host species among teleost fishes and affects cyprinids both in fish farms and natural waters. In addition, while L. cyprinacea infection in amphibians has been recorded in Asia, North and South America, there is no data available in the literature on their presence in Europe. In this study, we first reported L. cf. cyprinacea parasitising an anuran tadpole in Europe. Specimens of L. cf. cyprinacea were observed attached to a tadpole of the agile frog (Rana dalmatina), which was caught during fishing of crucian carp fingerlings (Carassius carassius) from a small fish pond in Hungary during the summer of 2012. The infected tadpole was collected from a rearing pond, where juvenile crucian carps were kept. The tadpole was inspected in the laboratory, and digital photos were taken. The parasites were found attached to the body-tail junction and to the leg of the tadpole (at Gosner stage 41). The parasite species was identified as L. cf. cyprinacea based on morphological traits.

Significance of Hemorheological Tests During Mycoplasma Pulmonis Infection in Laboratory Rats

Mycoplasma pulmonis (M. pulmonis) is a chronic infection that can appear in laboratory animal facilities. Deviations in hemorheological parameters during many pathological processes were detected, but it is unknown to what extent M. pulmonis infection causes changes in micro-rheological parameters. We performed our study on 25 symptomatic and asymptomatic Wistar rats, randomly selected from the entire population and presumably infected with Mycoplasma. From the blood samples, we determined the hematological parameters, red blood cell deformability under varying shear stress and varying osmolality, and the degree of red blood cell aggregation. We used the data of age- and sex-matched animals from our previous research as a control. Red blood cell count, hemoglobin, hematocrit values, and platelet count were significantly reduced in Mycoplasma-infected animals. Significantly reduced erythrocyte aggregation and deformability were detected. In conclusion, M. pulmonis infection causes significant changes in hemorheological and hematological parameters. Periodic measurement of these parameters can help monitor the infection.

[Pancreatic cancer with liver metastases: is it possible to improve survival by resection of oligopersistent primary tumor following neoadjuvant chemotherapy?]

The prognosis of pancreatic cancer is one of the worst of all cancers. Though the routine use of modern targeted and immunotherapy is still pending, the recently applied new chemotherapy combinations resulted in obvious improvement in the clinical management of pancreatic cancer. Adjuvant treatment followed by radical operation can increase the survival of the patients, moreover, neoadjuvant therapy for locally advanced tumors is associated with higher resectability rate. However, in metastatic disease only palliative chemotherapy could be indicated due to the dismal prognosis. The introduction of new chemotherapy combinations produced a major evolution by extending the median survival time of these patients. According to recent publications, even complete remission of the metastases can be achieved by the palliative chemotherapy, justifying a radical operation. This approach can be more advantageous, compared to patients treated with chemotherapy only. Reporting our two primary metastatic cases, we also endorse this new approach. The clinical significance of complex management is justified in the case of oligopersistence which is traditionally treated only with palliative systemic therapy. Orv Hetil. 2023; 164(43): 1712-1718.

[Neurosurgical management for metastatic brain tumors in renal cell carcinoma]

The therapeutic approach to brain metastases has changed significantly in the last 30 years. The development of surgical technique, the use of new MRI techniques, preoperative surgical planning and the administration of intraoperative navigation reduced the risks of surgery and improved the results. In the case of aggressive renal cell carcinomas, we detect brain metastases relatively often, which are difficult to treat, but the improved surgical and radiosurgery techniques can also be used with success. In our report, we present the neurosurgical management of metastatic spreading of renal cell carcinoma to the brain. Modern surgical planning and more precise, tailored approach with modern radiosurgery techniques are able to improve the outcome and prolong survival even in aggressive types of renal cell carcinomas that give rise to brain metastases. In more severe cases and even in the case of multiple brain metastases, cranial surgery can be recommended.