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Introduction . Our previous research showed that the gamma knife surgery (GKS) is a highly effective treatment for intracanalicular vestibular schwannomas (IVS). In the current study, we aimed to evaluate long‐term quality of life (QoL) as a follow‐up to the assessment of baseline clinical and demographic parameters in the original study. Moreover, QoL outcomes were compared with norms for the general population and for patients who underwent different ear, nose, and throat (ENT) procedures. Materials and Methods . The follow‐up study included 92 patients (59 women and 33 men; mean age, 61.71 ± 12.55 years; range: 32‐85 years) with unilateral IVS who underwent GKS. Patients completed the Assessment of Quality of Life , Penn Acoustic Neuroma Quality‐of‐Life, Glasgow Benefit Inventory, and WHO‐5 Well‐being Index questionnaires as well as a demographic survey. Neurosurgical parameters were assessed using the Koos and House‐Brackmann scales and the results of audiological examinations. Results and Conclusions . QoL scores were within or above the norm in 38% of patients. There were significant differences in terms of comorbidities and emotional well‐being between patients with QoL scores within or above the norm and patients with QoL scores below the norm. Comorbidities were more common in patients with QoL scores below the norm, and they influenced reported QoL ( p = 0.009). Patients with QoL scores within or above the norm reported better emotional well‐being than those with QoL scores below the norm. Long‐term QoL outcomes were satisfactory, consistent with the results of the original study. Although GKS is a complex procedure, patients reported higher QoL than those using hearing aids and the same QoL as those after ENT surgery or reassurance. However, they reported a slightly lower QoL than patients taking ENT medications. GKS appears to be a promising treatment option for patients with IVS.

The high frequency of traumatic brain injury imposes severe economic stress on health and insurance services. The objective of this study was to analyze the association between the serum S100B protein, the Gosling pulsatility index (PI), and the level of oxygen saturation at the tip of the internal jugular vein (SjVO2%) in patients diagnosed with severe TBI. The severity of TBI was assessed by a GCS score≤8 stratified by Glasgow outcome scale (GOS) measured on the day of discharge from the hospital. Two groups were included: GOS<4 (unfavorable group (UG)) and GOS≥4 (favorable group (UG)). S100B levels were higher in the UG than in the FG. PI levels in the UG were also substantially higher than in the FG. There were similar levels of SjVO2 in the two groups. This study confirmed that serum S100B levels were higher in patients with unfavorable outcomes than in those with favorable outcomes. Moreover, a clear demarcation in PI between unfavorable and FGs was observed. This report shows that mortality and morbidity rates in patients with traumatic brain injury can be assessed within the first 4 days of hospitalization using the S100B protein, PI values, and SjVO2.

Intracanalicular vestibular schwannomas (IVS) account for 8% of all vestibular schwannomas and their detection is still increasing due to high availability of magnetic resonance (MRI). Radiosurgery is one of several commonly acceptable methods of IVS treatment, but some risk may still exist with that treatment. The aim of this study is to analyze the clinical outcomes in tumor control and hearing preservation after radiosurgery of IVS. The retrospective analysis included 14 scientific papers available in the PubMed database. Assessment of tumor volume was performed based on gadolinium-enhanced T1-weighted scans. Hearing preservation was assessed using the Gardner-Robertson classification (GR class). Statistical analysis was performed using IBM SPSS Statistics 27. It was revealed that tumor growth control in IVS treated with radiosurgery was higher than in the wait-and-see strategy. The hearing preservation was similar in patients after wait and see and the surgical group. Radiosurgery was associated with low risk of facial nerve dysfunction.

Craniocerebral injury (CBI) is tissue damage caused by a sudden mechanical force. CBI can result in neurological, neuropsychological and psychiatric dysfunctions. Currently, the severity of CBI is assessed using the Glasgow Coma Scale, brain perfusion pressure measurements, transcranial Doppler tests and biochemical markers. This study aimed to determine the applicability of the S-100B protein levels and the time-averaged mean maximum cerebral blood flow velocity (Vmean) as a means of predicting the treatment outcomes of CBI in the first 4 days of hospitalization. The results validated the standard reference ranges previously proposed for the concentration of S-100B (0.05-0.23 µg/l) and the mean of cerebral blood flow velocity (30.9 to 74.1 cm/sec). The following stratification scheme was used to predict the success of treatment: Patients with a Glasgow Outcome Scale (GOS) score ≥4 or GOS <4 were stratified into 'favorable' and 'unfavorable' groups, respectively. The favorable group showed relatively constant levels of the S-100B protein close to the normal range and exhibited an increase in Vmean, but this was still within the normal range. The unfavorable group exhibited a high level of S-100B protein and increased Vmean outside of the normal ranges. The changes in the levels of S-100B in the unfavorable and favorable groups were -0.03 and -0.006 mg/l/h, respectively. Furthermore, the rate of decrease in the Vmean value in the unfavorable and favorable groups were -0.26 and -0.18 cm/sec/h, respectively. This study showed that constant levels of S-100B protein, even slightly above the normal range, associated with an increase in Vmean was indicative of a positive therapeutic outcome. However, additional research is required to obtain the appropriate statistical strength required for clinical practice.

Background/Objectives: Surgical resection of medium to large vestibular schwannomas (VSs, Koos grade 3 and 4) is a widely used approach, although stereotactic radiosurgery (SRS) is increasingly proposed as initial treatment. The quality of life-centered approach is challenged in cases where tumor growth control cannot be achieved with SRS, thus necessitating salvage surgery. We present a series of eight consecutive patients who required surgery due to continued tumor growth after SRS. Methods: Of the 146 patients with VS grades 3 and 4 initially treated with SRS, only eight patients (mean age, 54 ± 7.2 years; range, 42–63 years) required subsequent surgery. Their mean tumor volume was 9.9 ± 3.2 cm3. The mean time from SRS to first tumor progression and planned subtotal resection was 23 ± 5.9 months and 45 ± 17.5 months, respectively. SRS was not performed after the surgery in favor of a “wait and rescan” approach. Tumor residue was monitored on follow-up magnetic resonance imaging. In all patients, tumor growth control after planned subtotal resection was maintained at 63 ± 19.8 months. Results: None of the 146 patients had serious complications after SRS. In the eight patients who required surgery, tumor growth between 22% and 212% (mean, 4 cm3) was reported within 26 to 84 months after SRS. Before salvage surgery, they scored 1 point on the House–Brackmann scale. Subtotal excision was performed, and VIIth nerve function was preserved in all patients. At 63 ± 19.8 months, 3 patients had a House–Brackmann score of 1, four patients had a score of 2, and one patient had a score of 3. Conclusions: Surgical excision of medium to large VS after SRS can be relatively safe, provided that a quality of life-centered approach of subtotal resection is used.

The patient was on continuous treatment with steroid and thyroid hormone replacement therapy. The authors conclude that the pimozide which blocks the central nervous system dopaminergic receptors remains useful for choreoathetosis and motor and phonic tics in the Tourette syndrome.

Unilateral gamma knife thalamotomy (GKT) is a treatment option for pharmacoresistant tremor of various aetiologies. There have been to date no randomised controlled trials performed to assess its safety and efficacy. Our aim was to summarise a two-year multimodal observation of patients with tremor caused by Parkinson's Disease (PD) or essential tremor (ET). 23 patients with PD (n = 12) or ET (n = 11) were included. They underwent assessments before, V0 (n = 23), and 12 months, V12 (n = 23), and 24 months, V24 (n = 15), after unilateral GKT. Patients were assessed with psychological tests and acoustic voice analysis. Tremor assessment was performed with a digitising table using the Fahn-Tolosa-Marin rating scale (FTMRS). The Unified Parkinson's Disease rating scale part III (UPDRS-III) was also used in the PD group. Gait and balance was assessed using clinical tests, stabilometric platform, and treadmill. No side effects were observed in a two-year follow-up. There was no notable deterioration observed in the patients' psychological evaluation, speech, or assessment of gait and balance. The scores were significantly lower (p = 0.01) in parts A and B of FTMRS one year after GKT. In post hoc analysis, the scores did not differ significantly between V0 and V24. In FTMRS part C (activities of daily living), no significant change was observed. There was no significant difference in total UPDRS part III score or in score of UPDRS part III domains 3 and 4 ('tremor at rest' and 'action and postural tremor of hands') between measurements. UGKT may be a safe treatment modality if performed in an experienced centre. Tremor reduction may diminish over time, and UGKT did not lead to cognitive, gait or speech deterioration in a long-term observation.

Primary generalized dystonia (PGD) is a medically refractory progressive disease of the brain causing near total handicap of affected patients. The aim of the study was to assess the efficacy and safety of bilateral pallidal stimulation in patients with PGD. The study population is composed of 5 patients with PGD. The formal objective assessment included the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). All stereotactic procedures were performed in general anaesthesia using a Leksell G stereotactic head frame without electrophysiological guidance. Immediately after insertion of deep brain stimulation (DBS) leads, the internal pulse generators (Itrel II or Soletra) were implanted subcutaneously in the chest wall or abdominal region. There were no complications related to the stereotactic procedures. The hardware-related complications (two broken DBS leads) were replaced successfully. There were no infections or erosions of implanted hardware. It has been observed that in the long-term follow-up period primary set bipolar stimulation mode lost its benefit achieved previously. Various stimulation combinations were investigated. Monopolar cathodal or especially multi-contact cathodal stimulation was the most effective one. The efficacy of bilateral pallidal stimulation was proved by the objective validated BFMDRS at long-term follow-up. Response to DBS may improve with the number of activated cathodal contacts within the globus pallidus internus. Pierwotna dystonia uogólniona to postępujące, oporne na leczenie farmakologiczne schorzenie, które prowadzi do prawie całkowitego inwalidztwa dotkniętych nim chorych. Celem tej pracy jest ocena skuteczności i bezpieczeństwa obustronnej stymulacji części wewnętrznych gałek bladych u chorych z pierwotną dystonią uogólnioną. Badaną grupę stanowiło 5 pacjentów. Stopień nasilenia dystonii oceniono obiektywnie w skali Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Wszystkie operacje stereotaktyczne przeprowadzono w znieczuleniu ogólnym z wykorzystaniem ramy stereotaktycznej Leksell G bez śródoperacyjnego badania elektrofizjologicznego. Bezpośrednio po wszczepieniu elektrod do głębokiej stymulacji mózgu, generatory impulsów (Itrel II lub Soletra) wszczepiono podskórnie w okolice klatki piersiowej lub powłoki jamy brzusznej. Nie obserwowano powikłań związanych z operacjami stereotaktycznymi. Dwie uszkodzone – przerwane – elektrody do głębokiej stymulacji mózgu wymieniono bez powikłań. Nie stwierdzono zakażeń ani nadżerek wszczepionych elementów do głębokiej stymulacji mózgu. W obserwacji pooperacyjnej zauważono, że stymulacja bipolarna zaczęła tracić swój korzystny efekt widoczny w bezpośrednim okresie pooperacyjnym. U chorych próbowano zastosować różne kombinacje aktywnych kontaktów wszczepionych elektrod. Okazało się, że najskuteczniejsza jest stymulacja katodalna, a szczególnie wielokontaktowa stymulacja katodalna. Skuteczność stymulacji katodalnej potwierdzono w obserwacji długoterminowej na podstawie skali BFMDRS. Skuteczność głębokiej stymulacji mózgu może się zwiększać wraz z liczbą aktywnych kontaktów jako katody w zakresie części wewnętrznej gałki bladej.

The authors report a case of bilateral globus pallidus internus (GPi) stimulation for treatment of medically intractable isolated lower limb dystonia. The 14-year-old girl developed dystonic movements in her left lower limb. At the age of 17, the patient was handicapped by dystonic movements in her lower limbs, and became wheelchair-bound. Pharmacological therapy and botulinum toxin injection resulted in transient and modest benefit. Moreover, the patient was diagnosed with histologically proven coeliac disease and Langerhans cell histiocytosis. Genetic testing revealed the presence of DYT-1 mutation. The 17-year-old girl underwent bilateral implantation of deep brain stimulation leads. Bilateral GPi stimulation resulted in remarkable improvement of phasic dystonic movements, and dystonic posture of lower limbs. Over 2 years postoperative follow-up, the patient is able to walk independently. Bilateral GPi stimulation appears to be an effective treatment modality for isolated lower limb dystonia. Autorzy przedstawiają przypadek chorej poddanej obustronnej stymulacji części wewnętrznej gałki bladej z powodu izolowanej dystonii kończyn dolnych. U 14-letniej dziewczynki zaobserwowano ruchy dystoniczne obejmujące początkowo lewą kończynę dolną. Stopniowo ruchy dystoniczne objęły również prawą kończynę dolną. W wieku 17 lat dystonia w znacznym stopniu upośledzała życie chorej, która poruszała się wyłącznie na wózku inwalidzkim. Farmakoterapia i wstrzyknięcia toksyny botulinowej przyniosły niewielką i przejściową poprawę. Badanie genetyczne wykazało obecność mutacji DYT-1. Chorą skierowano do leczenia operacyjnego. W wieku 17 lat przeszła operację obustronnej implantacji elektrod do głębokiej stymulacji mózgu. Obustronna stymulacja GPi przyczyniła się do znacznego zmniejszenia ruchów dystonicznych i wymuszonego dystonicznego ustawienia kończyn dolnych. Podczas dwuletniej obserwacji pacjentka zaczęła chodzić samodzielnie. Obustronna stymulacja GPi wydaje się skuteczną metodą leczenia izolowanej dystonii kończyn dolnych.