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Dostal J, Mracek J, Heidenreich F, Priban V. Delayed microsurgical revascularization in an acute ischemic stroke based on perfusion study. Acta Neurochir (Wien) 2023; 165:3825-3830. [PMID: 37910307 DOI: 10.1007/s00701-023-05860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery - left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.
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Affiliation(s)
- Jiri Dostal
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Jan Mracek
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Filip Heidenreich
- Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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2
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Trkova K, Sumerauer D, Krskova L, Vicha A, Koblizek M, Votava T, Priban V, Zapotocky M. DIPG-like MYB-altered diffuse astrocytoma with durable response to intensive chemotherapy. Childs Nerv Syst 2023; 39:2509-2513. [PMID: 37165121 PMCID: PMC10432314 DOI: 10.1007/s00381-023-05976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
Pontine gliomas represent difficult to treat entity due to the location and heterogeneous biology varying from indolent low-grade gliomas to aggressive diffuse intrinsic pontine glioma (DIPG). Making the correct tumor diagnosis in the pontine location is thus critical. Here, we report a case study of a 14-month-old patient initially diagnosed as histone H3 wild-type DIPG. Due to the low age of the patient, the MRI appearance of DIPG, and anaplastic astrocytoma histology, intensive chemotherapy based on the HIT-SKK protocol with vinblastine maintenance chemotherapy was administered. Rapid clinical improvement and radiological regression of the tumor were observed with nearly complete remission with durable effect and excellent clinical condition more than 6.5 years after diagnosis. Based on this unexpected therapeutic outcome, genome-wide DNA methylation array was employed and the sample was classified into the methylation class "Low-grade glioma, MYB(L1) altered." Additionally, RT-PCR revealed the presence of MYB::QKI fusion. Taken together, the histopathological classification, molecular-genetic and epigenetic features, clinical behavior, and pontine location have led us to reclassify the tumor as a pontine MYB-altered glioma. Our case demonstrates that more intensive chemotherapy can achieve long-term clinical effect in the treatment of MYB-altered pontine gliomas compared to previously used LGG-based regimens or radiotherapy. It also emphasizes the importance of a biopsy and a thorough molecular investigation of pontine lesions.
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Affiliation(s)
- Katerina Trkova
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
| | - David Sumerauer
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
| | - Lenka Krskova
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
| | - Ales Vicha
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
| | - Miroslav Koblizek
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic
| | - Tomas Votava
- Department of Pediatrics, University Hospital in Pilsen, Alej Svobody 80, Pilsen-Lochotin, 323 00, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, University Hospital in Pilsen, Alej Svobody 80, Pilsen-Lochotin, 323 00, Czech Republic
| | - Michal Zapotocky
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic.
- Pediatric Neurooncology Centre, University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic.
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, V Uvalu 84, 15006, Prague 5, Czech Republic.
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3
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May M, Sedlak V, Pecen L, Priban V, Buchvald P, Fiedler J, Vaverka M, Lipina R, Reguli S, Malik J, Netuka D, Benes V. Role of risk factors, scoring systems, and prognostic models in predicting the functional outcome in meningioma surgery: multicentric study of 552 skull base meningiomas. Neurosurg Rev 2023; 46:124. [PMID: 37219634 PMCID: PMC10205827 DOI: 10.1007/s10143-023-02004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 05/24/2023]
Abstract
Despite the importance of functional outcome, only a few scoring systems exist to predict neurologic outcome in meningioma surgery. Therefore, our study aims to identify preoperative risk factors and develop the receiver operating characteristics (ROC) models estimating the risk of a new postoperative neurologic deficit and a decrease in Karnofsky performance status (KPS). A multicentric study was conducted in a cohort of 552 consecutive patients with skull base meningiomas who underwent surgical resection from 2014 to 2019. Data were gathered from clinical, surgical, and pathology records as well as radiological diagnostics. The preoperative predictive factors of functional outcome (neurologic deficit, decrease in KPS) were analyzed in univariate and multivariate stepwise selection analyses. Permanent neurologic deficits were present in 73 (13.2%) patients and a postoperative decrease in KPS in 84 (15.2%). Surgery-related mortality was 1.3%. A ROC model was developed to estimate the probability of a new neurologic deficit (area 0.74; SE 0.0284; 95% Wald confidence limits (0.69; 0.80)) based on meningioma location and diameter. Consequently, a ROC model was developed to predict the probability of a postoperative decrease in KPS (area 0.80; SE 0.0289; 95% Wald confidence limits (0.74; 0.85)) based on the patient's age, meningioma location, diameter, presence of hyperostosis, and dural tail. To ensure an evidence-based therapeutic approach, treatment should be founded on known risk factors, scoring systems, and predictive models. We propose ROC models predicting the functional outcome of skull base meningioma resection based on the age of the patient, meningioma size, and location and the presence of hyperostosis and dural tail.
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Affiliation(s)
- Michaela May
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic.
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Vojtech Sedlak
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Ladislav Pecen
- Institute of Computer Science, The Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Pavel Buchvald
- Department of Neurosurgery, Liberec Hospital, Liberec, Czech Republic
| | - Jiri Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Miroslav Vaverka
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Stefan Reguli
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jozef Malik
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Polivka J, Svajdler M, Priban V, Mracek J, Kasik P, Martinek P, Ptakova N, Bagheri MS, Shetti D, Pesta M, Potuznik P, Topolcan O. Oncogenic Fusions in Gliomas: An Institutional Experience. Anticancer Res 2022; 42:1933-1939. [PMID: 35347013 DOI: 10.21873/anticanres.15671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Gliomas are primary malignancies of the central nervous system (CNS). High-grade gliomas are associated with poor prognosis and modest survival rates despite intensive multimodal treatment strategies. Targeting gene fusions is an emerging therapeutic approach for gliomas that allows application of personalized medicine principles. The aim of this study was to identify detectable fusion oncogenes that could serve as predictors of currently available or newly developed targeted therapeutics in cross-sectional samples from glioma patients using next-generation sequencing (NGS). PATIENTS AND METHODS A total of 637 patients with glial and glioneuronal tumours of the CNS who underwent tumour resection between 2017 and 2020 were enrolled. Detection of fusion transcripts in FFPE tumour tissue was performed by a TruSight Tumour 170 assay and two FusionPlex kits, Solid Tumour and Comprehensive Thyroid and Lung. RESULTS Oncogene fusions were identified in 33 patients. The most common fusion was the KIAA1549-BRAF fusion, detected in 13 patients, followed by FGFR fusions (FGFR1-TACC1, FGFR2-CTNNA3, FGFR3-TACC3, FGFR3-CKAP5, FGFR3-AMBRA1), identified in 10 patients. Other oncogene fusions were also infrequently diagnosed, including MET fusions (SRPK2-MET and PTPRZ1-MET) in 2 patients, C11orf95-RELA fusions in 2 patients, EGFR-SEPT14 fusion in 2 patients, and individual cases of SRGAP3-BRAF, RAF1-TRIM2, EWSR1-PALGL1 and TERT-ALK fusions. CONCLUSION The introduction of NGS techniques provides additional information about tumour molecular alterations that can aid the multimodal management of glioma patients. Patients with gliomas positive for particular targetable gene fusions may benefit from experimental therapeutics, enhancing their quality of life and prolonging survival rates.
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Affiliation(s)
- Jiri Polivka
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Marian Svajdler
- Sikl's Department of Pathology, University Hospital Pilsen, Pilsen, Czech Republic; .,Biopticka laboratory s.r.o, Pilsen, Czech Republic.,Cytopathos, s.r.o., Bratislava, Slovak Republic
| | - Vladimir Priban
- Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Mracek
- Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Petr Kasik
- Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | | | | | - Mahyar Sharif Bagheri
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Dattatrya Shetti
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Pesta
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Potuznik
- Department of Neurology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Ondrej Topolcan
- Department of Immunochemical Diagnostics, University Hospital Pilsen, Pilsen, Czech Republic
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Mraček J, Mork J, Dostal J, Tupy R, Mrackova J, Priban V. Complications Following Decompressive Craniectomy. J Neurol Surg A Cent Eur Neurosurg 2021; 82:437-445. [PMID: 33618416 DOI: 10.1055/s-0040-1721001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications. METHODS We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed. RESULTS DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome. CONCLUSIONS The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.
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Affiliation(s)
- Jan Mraček
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Mork
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jiri Dostal
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Radek Tupy
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jolana Mrackova
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
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Mracek J, Kletecka J, Holeckova I, Dostal J, Mrackova J, Mork J, Priban V. Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy. J Neurol Surg A Cent Eur Neurosurg 2019; 80:341-344. [PMID: 31035296 DOI: 10.1055/s-0039-1688692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND STUDY AIMS Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. MATERIAL AND METHODS The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. RESULTS CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. CONCLUSION Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.
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Affiliation(s)
- Jan Mracek
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Jakub Kletecka
- Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Irena Holeckova
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Jiri Dostal
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Jolana Mrackova
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Jan Mork
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen - Pilsen, Czech Republic
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Mracek J, Kletecka J, Mork J, Stepanek D, Dostal J, Mrackova J, Priban V. Indications for General versus Local Anesthesia during Carotid Endarterectomy. J Neurol Surg A Cent Eur Neurosurg 2019; 80:250-254. [DOI: 10.1055/s-0039-1678601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Study Aims Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA.
Material and Methods The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients.
Results GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5).
Conclusion GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.
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Affiliation(s)
- Jan Mracek
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jakub Kletecka
- Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Mork
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - David Stepanek
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jiri Dostal
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jolana Mrackova
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
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Polivka J, Polivka J, Holubec L, Kubikova T, Priban V, Hes O, Pivovarcikova K, Treskova I. Advances in Experimental Targeted Therapy and Immunotherapy for Patients with Glioblastoma Multiforme. Anticancer Res 2017; 37:21-33. [PMID: 28011470 DOI: 10.21873/anticanres.11285] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/03/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022]
Abstract
Glioblastoma multiforme (GBM) represents the most malignant primary brain tumor in adults with generally dismal prognosis, early clinical deterioration and high mortality. GBM is extremely invasive, characterized by intense and aberrant vascularization and high resistance to multimodal treatment. Standard therapy (surgery, radiotherapy and chemotherapy with temozolomide) has very limited effectiveness, with median overall survival of patients no longer than 15 months. Progress in genetics and epigenetics of GBM over the past decade has revealed various aberrations in cellular signaling pathways, the tumor microenvironment, and pathological angiogenesis. A number of targeted anticancer drugs, such as small-molecule kinase inhibitors and monoclonal antibodies, have been evaluated in clinical trials with newly-diagnosed, as well as recurrent GBM. Unfortunately, to date, only a single anti-angiogenic agent, bevacizumab, has been approved for the treatment of recurrent GBM in the USA and Canada. The novel possibilities of cancer immunotherapy, especially immune checkpoint inhibitors, are being evaluated in clinical trials of patients with GBM. The most recent clinical experiences with targeted therapy as well as immunotherapy of GBM are given in this review. The relative lack of success of some of these approaches recently revealed in well-designed randomized clinical trials is also discussed.
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Affiliation(s)
- Jiri Polivka
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Jiri Polivka
- Department of Neurology, Faculty of Medicine in Plzen, Charles University, Faculty Hospital Plzen, Plzen, Czech Republic
| | - Lubos Holubec
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Tereza Kubikova
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Faculty of Medicine in Plzen, Charles University, Czech Republic and Faculty Hospital Plzen, Plzen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, and Faculty Hospital Plzen, Plzen, Czech Republic
| | - Kristyna Pivovarcikova
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, and Faculty Hospital Plzen, Plzen, Czech Republic
| | - Inka Treskova
- Department of Surgery, Faculty of Medicine in Plzen, Charles University, and Faculty Hospital Plzen, Plzen, Czech Republic
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Smrcka M, Priban V, Brichtova E, Juran V. PT-12 * SURGICAL APPROACH FOR THALAMIC TUMORS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou266.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Mork J, Stepanek D, Holeckova I, Hommerova J, Ferda J, Priban V, Mracek J. Urgent Extracranial-Intracranial Bypass in the Treatment of Acute Hemodynamic Ischemic Stroke: Case Report. J Neurol Surg A Cent Eur Neurosurg 2013; 74:325-31. [DOI: 10.1055/s-0032-1331381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jan Mork
- Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - David Stepanek
- Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Irena Holeckova
- Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Jolana Hommerova
- Neurological Clinic, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Jiri Ferda
- Radiodiagnostic Clinic, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Jan Mracek
- Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
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Sokol D, Fiedler J, Chlouba V, Bombic M, Priban V. Endarterectomy for asymptomatic carotid artery stenosis under local anaesthesia. Acta Neurochir (Wien) 2011; 153:363-9. [PMID: 21104280 DOI: 10.1007/s00701-010-0806-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/10/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND In this article, we present our experience with such operations performed under local anaesthesia. METHODS From January 1997 to November 2007, there were 387 patients operated on for asymptomatic carotid stenosis. Patient data were retrospectively evaluated. Thirty-day neurological morbidity and mortality from six different subgroups were analysed and compared. The numbers of perioperative transient ischaemic attacks, as well as surgical and other perioperative complications were also evaluated. RESULTS Overall morbidity and mortality was 1.8% (seven patients). Stroke was noted in 1.3% (five patients). Transitory ischaemic attacks within the first 30 days were observed in 1.6% (six patients). Only those patients who had intraluminal shunt insertion were found to have significantly higher morbidity and mortality. (p = 0.000018). Myocardial infarction was observed in 0.5% (two patients), one fatal. CONCLUSION We have achieved acceptable morbidity and mortality rates (1.8%) according to the parameters set by previous studies such as Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Stenosis Trial as well as American Heart Association and European Stroke Organisation guidelines. All surgeries were done under local anaesthesia. Shunts were inserted in 22 cases (5.68%).
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