BACKGROUND:The aim of this paper was to point out the intradural cranial nerve roots variations in their localization and number to establish the incidence and clinical importance of the cranial nerve root variations.METHODS:The anatomical study was performed on 120 sides in 60 cadavers. There were 51 male cadavers with the mean age 43.3 and 9 female cadavers with the mean age of 39.5 years.RESULTS:Abducens nerve variations were observed in 48 cases (80 %). They were more frequently on the left side, in 25 cases (41.66 %). Duplicated abducens nerve was observed in 25 cases (41.66 %). Double and triple abducens nerve variations were also observed.CONCLUSIONS:Cranial nerve variations are rare, but variations of abducens nerve and atypical exit of the hypoglossal nerve from the fossa cranium posterior is not a rare variation. Knowledge of this variation may be important to various fields of medicine (Tab. 3, Fig. 8, Ref. 34).

INTRODUCTION:Anti-inflammatory effect of vitamin D (VD) could be beneficial in improving the survival of glioma patients. The aim of our study was to analyse the serum levels of vitamin D in glioma patients and to find an association with the prognosis of glioma patients and other investigated parameters.MATERIAL AND METHODS:The study included 63 patients with gliomas. Percentage of CD14+ monocytes, TREM-1+ and TREM-2+ monocytes were determined by flow cytometry, serum levels of 25(OH)D were evaluated by electrochemiluminescent binding test.RESULTS:Six patients out of 63 had normal levels of VD. A significant difference in the overall survival (OS) in the patients with severe VD deficiency, VD deficiency and insufficiency in grade IV was found. In grade II and III, the levels of vitamin D positively correlated with the percentage of TREM-2+ monocytes, and in grade II also a negative correlation of VD with TREM-1/TREM-2 ratio was observed.CONCLUSION:Levels of VD could influence the prognosis of patients with high-grade gliomas. Serum level of 25(OH)D in low-grade gliomas positively correlated with the percentage of anti-inflammatory acting TREM-2+ monocytes and negatively with TREM-1/TREM-2 ratio. This could be protective against the progression to high-grade glioma, because TREM-2 is associated with protective functions such as: tissue repair, control of local inflammation, or phagocytosis (Tab. 4, Fig. 4, Ref. 79).

Objective. In recent years, the role of the modern inflammatory markers TREM-1 (triggering receptors expressed on myeloid cells) and HMGB1 (high mobility group box 1 protein) in tumorigenesis has begun to be studied. Their role in gliomas is not clear. The aim of our study was to find the role of inflammation in gliomas. Patients and Methods. In 63 adult patients with gliomas and 31 healthy controls, the expressions of TREM-1 and TREM-2 on CD14(+) blood cells (method: flow cytometry) and the levels of soluble sTREM-1, HMGB1, IL-6, and IL-10 (Elisa tests) were analyzed. Results. Cox proportional hazard analysis showed that a TREM-1/TREM-2 ratio was associated with reduced overall survival (HR=1.001,P=0.023). Patients with a TREM-1/TREM-2 ratio above 125 survived significantly shorter than patients with a TREM-1/TREM-2 ratio below 125. The percentage of CD14(+)TREM-1(+)cells was strongly associated with a plasma IL-6/IL-10 ratio (positively) and with IL-10 (negatively). Conversely, we found a higher percentage of CD14(+)TREM-2(+)monocytes in better surviving patients; these cells could downregulate the exaggerated inflammation and potentiate the phagocytosis in the tumor. The serum levels of HMGB1 negatively correlated with the percentage of CD14(+)TREM-1(+)cells and with the TREM-1/TREM-2 ratio. The positive correlation between the serum levels of a late proinflammatory cytokine HMGB1 with the percentage of TREM2(+)CD14(+)monocytes can be explained as an effort for suppression of systemic inflammation by anti-inflammatory acting CD14(+)TREM-2(+)cells. Conclusion. We showed that the TREM-1/TREM-2 ratio (expression on the surface of blood monocytes) could help predict prognosis in patients with gliomas, especially in high-grade gliomas, and that systemic inflammation has an impact on the patient's overall survival. This is the first study that showed that TREM expression on monocytes in peripheral blood could help predict prognosis in patients with gliomas.

THE AIM of this work is to point out the intraspinal anatomical current occurrence interconnections between intradural and extradural nerve roots and their possible participation in radiculopathy. METHODS: The anatomical study was performed in 43 cadavers with a mean age of 53.7. All intradural and extradural rami communicantes between nerve roots were excised and examined histologically for the presence or absence of nervous tissue. RESULTS: Anatomical preparations revealed intradural and extradural rami communicantes in 9 cases (20.9 %), mostly in the cervical region in 5 cases and by plexus formation variations in 5 cases. Multiple extradural rami communicantes were observed in 6 cases (13.95 %), including the simultaneous occurrence of multiple intradural and extradural ones in 5 cases (11.6 %). CONCLUSIONS: This study allowed us to identify and describe unpublished intraspinal current occurrence intradural-extradural rami communicantes of nerve roots and their interrelationships throughout the spinal canal with their potential influence on the clinical picture (Tab. 1, Fig. 4, Ref. 25).

An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture.Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. Anterior approach was used in 15 of them, both posterior and anterior approaches were used in five of them. The prefixed type plexus formation was observed in eight cases (40 %). In these cases S1, S2 roots contributed to the formation of the pudendal nerve. In the postfixed type particularly the S3 root was dominant in two cases (66.7 %), and less the S4 root in one case (23.3 %) from three cases. Mostly the S2 root participated in its formation in 17 cases (85 %). The pudendal nerve branches run below the sacrospinous ligament on the level of the sacrospinous and sacrotuberous ligaments. The changes of the nerve and the branching therof were most evident from the anterior access below the sacrospinous ligament and in front of the sacrotuberous ligament. The inferior rectal nerve penetrating the sacrospinous ligament was seen in one case, it has risen from the pudendal nerve before entering the pudendal canal in four cases. The dorsal nerve of the penis has risen from the S1 root in two cases (10 %). We observed its branching before entering the pudendal canal in 15 cases (75 %). It has divided in the pudendal canal in other cases. This description may be useful particularly for the pudendal nerve block and the nerve saving surgeries directed on the relevant region (Fig. 8, Ref. 24).

We have performed a coordinated set of experiments to measure the electron impact ionisation and UV photoabsorption cross sections of α- and β-pinene. The adiabatic ionisation energies of α- and β-pinene were derived from experiment and found to be 8.3 and 8.6eV which compared well with high-level quantum chemical calculations (G3MP2) yielding values of 8.29 and 8.41eV. Additionally, vertical ionisation energies of 8.62 and 8.96eV were calculated using an OVGF method. UV photoabsorption cross sections were measured using a high-resolution synchrotron radiation source and electronic states interpreted on the basis of the TD quantum chemical methods.

Dissociative electron attachment (DEA) to halogenated derivatives of propane: 1-bromo-3-chloropropane, 2-bromo-1-chloropropane, 3-bromo-1,1,1-trichloropropane and 1,3-dibromo-1,1-difluoropropane was studied in the gas phase at ambient temperature using a high resolution crossed electron/molecule beams technique. The negative ions formed via DEA reaction were identified using mass spectrometric technique and the anion yields were measured in the electron energy range from 0 to 10eV. The absolute partial cross sections for DEA to the molecules were estimated using the relative flow technique.

OBJECTIVE:Neurofibromas of the vagus nerve on the neck are very rare. They are asymptomatic, slowly growing. We have seen only one case of neurofibroma of the vagus nerve in the mentioned location during last 22 years.CLINICAL PRESENTATION:33-year-old patient with negative family history. She has observed increasing swelling on the right side of the neck for about 2 years. She complained of the disorders of swallowing, expectoration, aspiration episodes, strider, intermittent palpitations, breathlessness, frequent airway infections. Magnetic resonance (MR) and angiography (AG) showed expansion in the mentioned location.CONCLUSION:We present our experiences with neurosurgical management of neurofibroma of the vagus nerve in the cervical portion using microscopic technique. We found only 9 described cases of surgical treatment of the neurofibroma of the vagus nerve in the neck location in available literature till 2007 (Fig. 6, Ref. 9).

OBJECTIVEThe study presents the results of reconstruction surgery of lesions on n. facialis with n. hypoglossus and n. accessorius performed in our clinic.PATIENT GROUP AND METHODS10 patients were treated by anastomosis of n. facialis with n. hypoglossus (HFA), 1 patient by anastomosis of n. facialis with n. accessorius (AFA). All operations were performed under the microscope; HFA and AFA anastomoses were sewed without tension at perineurium. The techique of suturation of facial nerves did not differ from the suturation of peripheral nerves in extremities. For the connection of n. VII-XII was not used plasma pasting. We did not use end to side anastomosis or reconstruction of n. VIIVII in pontocerebellar angle, in pyramid, or symetrical anastomoses of n. VII-VII, in any case. The results were objectivized by a VI grade Brudny's modification of House-Brackman classification introduced originally for scaling of the outcome of HFA anastomosis. In this study, this classification has been used for the objectivization of AFA anastomosis results.RESULTSReconstruction surgery by HFA and AFA resulted in all cases in grade III of the scale. Glossal hemiatrophy or atrophy of m. sternocleidomastoideus and m. trapesius were observed in patients treated by cross anastomosis with n. hypoglossus or n. accessorius. In patients treated by HFA and even more pronounced in patient with AFA anastomosis, minute synkineses in the region of labial angle, chin, also in the region of lower eyelid, occurred in the excited emotional state or during a long-lasting speech. Major diskincses were not observed in any of reported treatments. Recovery in older patients up to 60 years was coming more slowly, in one case after 6 months.CONCLUSIONCompared to AFA anastomosis, HFA anastomoses resulted in improved mimics and synkineses present here were finer. We prefer HFA anastomosis also because the discomfort caused by atrophy of ni. trapesius and ni. sternocleidomastoideus was apparently more perceived by patient treated by AFA than the negative effects of hemiatrophy reported by patients treated by FIFA.

The aim of this study is presentation of 3 cases reconstructive surgery of the skull base after cranio-cerebral injury.Injuries and methods: Extensive injuries of the skull base result in communication with paranasal cavities.Diagnostics: The most serious part of the operation is the isolation of the liquor space from the external environment. Reconstruction surgeries of the skull base have significantly improved in recent years due to development of new methods in diagnostics and treatment. 3D CT reconstruction has proven to be particularly valuable for the verification of liquorea even in patients with inactive liquorea at the time of examination, as well as in patients with no CT defects or with normal MR finding.Treatment: The use of firm and shapeable materials extends the possibilities of reconstruction surgery, the spectrum of surgical methods and approaches for extensive injuries of the skull base.

Aberrations observed during surgical treatments inspired us to initiate the investigation of variations in the formation of brachial plexus.We examined 55 adult cadavers in order to find out the incidence of neural variations. In the present work we focused on the deviations from the normal formation of brachial plexus and its terminal branches and their relation to surrounding structures that often determine the outcome of surgical treatment. The results of such anatomical studies are necessary for a more concise interpretation of peroperational as well as clinical findings.

Background: Meningiomas originating at the skull base orifices of the fifth to eleventh cranial nerves or medially to them often reach considerable size, may also involve middle cranial fossa, and may firmly adhere to surrounding structures. These relationships should be taken into consideration while planning surgical tactics including the approach and the extent of tumor excision.

OBJECTIVES:The study presents results of rare operations of the peripheral nerves compartment syndromes of the forearm and distal leg, completed in our clinic during a 14-year period (1990-2004).SUBJECTS AND METHODS:We completed 25 procedures for 25 compartment syndromes in 25 patients. All patients sufferred from unilateral compartment syndromes. The patients were operated for the first time in our clinic. None of them needed to be re-operated. The clinical pictures of the compartment syndromes were classified (three degrees) according to the Dellon's intensity classification: None of the patients sufferred from the Ist degree compression. The IInd degree occured in 4 patients (16%). The IIIrd degree occured in 21 patients (84%). The surgical procedure's effectiveness was analyzed, taking into consideration the degree of the compression, its duration and the symptoms duration.RESULTS:Excellent and good results were observed in all cases of the IInd degree compression and the symptoms duration up to 12 months. Worse results were recorded in the IIIrd degree compression cases, where excellent and good results were observed in 19 cases (76%). In cases, where the symptoms lasted for over 12 months, no excellent or good results were recorded.CONCLUSION:The decisive factor affecting the procedure's outcome, is the degree of the compression and its duration. The main factors improving the outcome of the procedure are the following: the patient's age up to 30 years of age and the duration of the symptoms up to 1 year, when the defect is not irreversible.

OBJECTIVES The authors present their results of 44 microsurgical procedures of 47 nerves in 44 patients subjects over a period of 19 years, from 1985 to 2003. STUDY GROUP SUBJECTS AND METHODS 44 patients with injuries to peripheral nerves of the upper extremities underwent reconstructions of 47 nerves using autotransplants. The procedures effectivity results were analysed using the following indicators: the injury to the procedure time, the patient's age, the autotransplant length, the injury type, the injury site, the injured nerve type. RESULTS The best results were reached: in young patients up to the age of 20, in cases of early operations up to 3 months, in cases when grafts up to 5 cm were used. Clean, for instance incision injury, has much better prospects for successful nerve graft autotransplantation than others, more complicated injuries (e.g. lacerated injury or contusion).

The mass spectrum and the appearance energies of the positive ions formed via electron impact ionization of l-alanine have been measured for the first time in a crossed electron-molecule beam experiment with a high-resolution electron beam. The ionization energy of the molecule and the appearance energies of the fragment ions were obtained from ion efficiency curves. Additionally, high-level quantum chemical calculations of the reaction enthalpies for dissociative ionization into positive ions and neutral radicals were performed and the results were compared with the experiment. On the basis of the calculations possible ionic structures for the measured ions were assigned. The value of the ionization energy for the parent ion with m/z=89 was determined experimentally to be 9.12±0.1eV. For the principal positive fragment ions with m/z of 74, 44 and 28 the experimental values of the appearance energies are 10.74±0.1, 9.10±0.05 and 10.85±0.1eV, respectively.

OUTCOME:In contrast to the CNS, peripheral nerves have the ability to regenerate. This ability has been utilized for a long time in the therapy of injuries of peripheral nerves. The aim of the present research was to assess the achievements in reconstructive surgery including nerve grafting and peripheral nerve suture repair in our clinic.MATERIAL AND METHODS:During the 16-year period from 1986 to 2001 we surgically treated 116 patients with peripheral nerve lesions. The cases of lesions of the brachial plexus, partial peripheral nerve lesions and postoperative revision, as well as the attempts of reconstruction of cervical nerves and neurolysis are not included in this work. We analysed the results of surgery in our patients who where subjected to treatment of peripheral nerves in the arms (95 patients) and legs (21 patients). In 53 patients reconstructive surgery was performed by suture repair of peripheral nerve, which included treatment of 65 nerves, 10 patients were treated by suture repair of 2 nerves and repair of 3 nerves in one patient. In 42 patients we reconstructed 45 peripheral nerves of the hand by autograft. The total number of 42 patients compromised 37 males and five females. The average age was 36 years. Double nerve reconstruction (ulnar and median) was accomplished in three patients. In the remaining 21 patients (14 males and seven females) we performed 21 reconstruction operations of 24 injured nerves in the lower extremities, of which 8 operations of 9 nerves involved suture repair of peripheral nerves and 13 operations of 15 nerves were performed using a nerve graft. Their average age was 39.7 years. The average period between primary treatment and operation was 6.7 months. In five cases the interval exceeded 12 months. Operations were performed by microtechnique. All patients were subject to several postoperational tests aimed at the estimation of the degree of recovery in sensory and motor adaptation. The evaluation was performed according the Seddon classification (1975). Motor recovery was evaluated according to a five-point scale and the degree of sensory recovery according to a four-point scale. Recovery of grade M4 and S3 (or higher) was considered an excellent or very good result and grades M3 and S2 were considered a good result. Results corresponding to grades M0-M2 and S0-S1 were considered to be insufficient.RESULTS AND CONCLUSION:The results of reconstruction operations of peripheral nerves injuries were dependent on the patient's age, the period between the injury and operation, the length of the autograft, the location of the injury, the type of injured nerve and the character of the injury (Fig. 2, Tab. 7, Ref: 15).

OUTCOME Aberrations observed during surgical treatments inspired us to initiate the investigation of variations in the formation of brachial plexus. MATERIAL AND METHODS 100 brachial plexuses in 50 cadavers were examined for the incidence of neural variations. We examined the involvement of the C4 root and eventually of that of Th2 root, as well as various deviations in the exit of individual roots and their branches from the backbone. We have focused also on their paths, anastomoses, on their thickness or on their eventual absence. In addition to the anatomical complexity and variability, the specifics of motor innervation related to diagnostics are also emphasized. The attention is paid to the mechanisms and morphological reasons of the occurrence of specific types of injuries. RESULTS Prefixed type was present in 24 cases (48 %), postfixed type was present just in one case. Aberrations have been observed in 14 cases (28 %). They occurred more frequently on the left side (9 cases) followed by two-sided aberrations (4 cases). CONCLUSION This study enabled to identify and describe exceptional and hitherto undescribed anatomical variations in the formation of nerve roots of brachial plexus.

Objectives Aberrations observed during surgical therapy has inspired us to investigate the variations of nervus axillaris formation. Material 100 brachial plexuses in 50 cadavers were examined for the incidence the variations of nervus axillaris. Results In 1 case (2%) we observed the aberration of nervus axillaris formation. Conclusion This study identifies and describes an exceptional anatomical variation--beginning n. axillaris as the continuance of the posterior branch of the upper trunk (Fig. 1, Ref. 2).