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Russian Neurosurgical Journal named after Professor A. L. Polenov

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Vol 14, No 2 (2022)

ЮБИЛЕИ

ORIGINAL PAPERS

9-12 16
Abstract

This paper presents a review of the literature and our own results concerning drug-induced osteoporosis in patients on anticonvulsant therapy. Data on the pathogenesis of bone mineral density disorders depending on the useddrugs and other factors determining the development of osteoporosis are discussed. Quantitative computed tomography data were analyzed in 53 epilepsy patients taking anticonvulsants. Disturbance of bone mineral density (BmD) in the form of osteopenia and osteoporosis was revealed in 23 patients (24 %). A reliable correlation between the number of risk factors and decreased BmD was revealed.

Additional study of pharmacogenetic and laboratory data of osteoporosis risk is required, consideration of which will allow planning of therapy and prescription of drugs regulating BmD in these categories of patients more accurately.

13-20 59
Abstract

The origin of pineal gland cysts (CSF) remains unclear to date, and the approach to their treatment is debatable. Linear sizes of cysts given in the literature are not comparable. There is also contradictory information about the frequency of CSF both in gender and age aspects. Some authors consider surgical intervention as a method of treating CSF, while others consider them random findings that do not even require dynamic observation.

PURPOSE. To study the frequency of occurrence of CSF according to the results of one MRI cabinet under the condition of natural occurrence of events (case-control).

MATERIAL AND METHODS. 5930 patients were examined, of which 300 had CSF, which was 5.06 % ± 0.56 %. The study was performed on a PhILIPS INTERA 1.5 tesla device, the following modes were used: FLAER_longTR, T1W_ FFE Sag, T2W_TSE Cor, T2W_TSE Tra, T1W_ FFE Tra, DW_SSh Tra. The volume of cysts was calculated by the formula: V=A×B×C×0.52, where A, B and C are the linear dimensions of the cyst.

RESULTS. In all age groups of patients of both sexes, cysts of ultra-small (up to 0.1 cm3) and small (from 0.11 to 0.5 cm3) volumes prevailed. Cysts of medium (from 0.51 cm3 to 1.0 cm3) and large (over 1.0 cm3) volume prevailed in persons of reproductive age and older than 40 years. Cysts with a content density higher than the density of the cerebrospinal fluid, both in women and men, were observed mainly at the reproductive age and over 40 years, although they occurred in the puberty period somewhat more often in boys.

CONCLUSIONS. Patients with medium and large volume cysts need dynamic monitoring. For persons with cystic transformation of the pineal gland, in combination with neurological or endocrine insufficiency, it is advisable to study the level of melatonin and other parameters of homeostasis.

21-23 65
Abstract

One of the reasons for patients’ dissatisfaction with surgical treatment is postoperative pain syndrome. It is known that inattention to pain relief in the early postoperative period can lead to the formation of a chronic pain syndrome.

PURPOSE. To compare the intensity of pain syndrome in the postoperative period with three methods of surgical treatment of carpal tunnel syndrome.

RESULTS. The difference in the intensity of the pain syndrome in the early postoperative period may be due to the size of the surgical access, the involvement of the palmar aponeurosis in the formation of the scar after 6 months. At the same time, the long-term results (one year after the surgical treatment) are comparable with different types of median nerve decompression (p<0.05).

24-28 20
Abstract

Innovations in medical equipment are far ahead of the accumulated experience of specialists, and one of the main problems of modern radiation diagnostics is the lack of standards for conducting magnetic resonance studies. The most frequent study during magnetic resonance imaging (MRI) is the study of brain structures. Carrying out MRI of the brain today causes difficulties both in the method of conducting and in interpreting the results obtained.

MATERIALS AND METHODS: 227 brain scan protocols for the following pathologies: acute and subacute intracerebral hemorrhage — 30.84 % (n=70), acute and subacute ischemic infarction — 30.84 % (n=70), abscess — 1.36 % (n=2), multiple sclerosis (pseudotumorous form) — 6.61 % (n=15), glioma — 30.84 % (n=70), metastatic lesion — 0.88 % (n=2). All studies were performed on Philips Achieva 1.5 T devices (Netherlands).

RESULTS. An optimized MRI scanning protocol for solitary formation of the white matter of the brain is proposed, which can be reproduced in medical institutions of 1–3 levels.

CONCLUSION. The standardized MRI protocol allows for the minimum time within one study to differentiate tumor and non-tumor pathology, to determine the tactics of patient management. For a reasonable conclusion within the differential series, a combination of methods and the application of the principles of a systematic approach are necessary.

29-36 26
Abstract

This study is based on the immediate and long-term results of endovascular treatment of cerebral aneurysms by their occlusion with detachable coils. Based on the literature data, as well as our own clinical observations, conclusions have been drawn about the effectiveness of isolated occlusion of cerebral aneurysms by detachable coils.

PURPOSE OF THE STUDY. To evaluate the immediate and long-term angiographic results of endovascular occlusion of aneurysms by detachable coils.

MATERIAL AND METHODS. The analysis of the immediate and long-term angiographic results of endovascular occlusion of 64 cerebral aneurysms with detachable coils operated in the clinic in the period from 2013 to 2016 was performed. The study included 47 women and 13 men aged 18 to 72 years.

RESULTS. Our results indicate a high frequency (36.8 % after 6 months, 58.5 % after 12 months, 54.8 % after 36 months) of unstable occlusion of cerebral aneurysms when using detachable coils. Subtotal occlusion in our series turned out to be the most unstable type of occlusion (class II according to the Raymond-Roy classification), which demonstrated a stable result in each of the control points in the range from 7.3 % to 16.2 % (p<0.05). At the same time, there is a possibility of a delayed increase in the radicality of aneurysm occlusion (thrombosis) (23.6 % after 6 months, 26.8 % after 12 months, 32.3 % after 36 months) due to delayed thrombosis of the aneurysm sac. In addition, there is a fairly high frequency of recurrence formation (13.1 % after 6 months, 31.7 % after 12 months, 22.6 % after 36 months). The formation of relapses averaged 22.5 %.

CONCLUSION. The technique of endovascular coil occlusion of aneurysms can be a fairly effective method of treatment, allowing to achieve total occlusion of aneurysms, however, requires a more detailed study of the criteria for selecting patients for surgical intervention. According to our data, complete total occlusion of the aneurysm is possible only in 51.6 % of cases, which requires a more careful approach to the choice of this technique for the treatment of patients with cerebral aneurysms. The favorable characteristics of the aneurysm, contributing to its radical occlusion, are the size of the neck in the range from 3 to 6 mm and the usual size of the aneurysm (4–15 mm) (p<0,05).

37-43 49
Abstract

INTRODUCTION: Glioblastomas are the most common malignant tumors of the nervous system in adults. In modern clinical practice, the assessment of the proliferative activity index by ki-67 in glial neoplasms is widely used. This article evaluates and describes the features of the interpretation of ki-67 values in the morphological diagnosis of gliomas.

PURPOSE: To evaluate the morphological criteria of intratumoral heterogeneity of glioblastomas, to determine the variability of nuclear marker values both between specialists and using different methods.

MATERIALS AND METHODS: 43 fragments from the central and marginal sections from 9 patients with glioblastomas who underwent surgical treatment at the N.N. prof. A. L. Polenov. Immunohistochemical study was performed with primary antibodies to GFAP (to confirm glial tumor differentiation) and Ki-67 (to assess proliferative activity). The level of proliferative activity for Ki-67 in each glass was calculated by two morphologists by a semi-automatic method using the ImageJ program, and also without the use of additional software in 5 fields of view at a magnification of x400, taking into account the average and maximum values. Statistical analysis was performed using the Statistica v 10 program.

RESULTS: a higher level of proliferative activity was found in the central part of glioblastomas. In the predominance of necrosis foci, relatively low values of proliferative activity for glioblastoma were revealed. In our laboratory, a comparative analysis of the calculation of the proliferative activity index by different pathologists did not reveal significant differences in the data obtained (p<0.05).

CONCLUSIONS: for morphological study, it is recommended to take biological material from the central metabolically active areas of gliomas. In cases of analysis of a small volume of material, the value of the level of proliferative activity increases. If the value of ki-67 is more than 10 %, the interpretation of the morphological picture of malignant astrocytoma towards glioblastoma is recommended. Semi-automatic and automatic calculation of proliferative activity significantly speeds up the determination of the Ki-67 index. The results obtained by counting through the eyepieces of the microscope do not differ from the counting and coincide with the data obtained by the semi-automatic method.

44-47 57
Abstract

Quantitative analysis of complications in neurosurgery is a permanently topical issue limited by the lack of a unified «complication» definition in the professional community, approaches to registering, surveillance, and classification of complications. These drawbacks, in turn, disable quantitative safety indicators comparison between different neurosurgical facilities, as well as large-scale epidemiological studies.

PURPOSE OF THE STUDY: to determine the actual tasks of studying complications in neurosurgery, taking into account the potential of modern artificial intelligence technologies and its usage examples in the research of the FSAI «NMRC named after ac. N. N. Burdenko» of the ministry of health of Russia.

MATERIALS AND METHODS: In the present work, we analyzed text medical records that were initially typed in using keyboard by doctors into the electronic health records system “E-med” of the FSAI «NMRC named after ac. N. N. Burdenko» of the ministry of health of Russia in the period between 2000 and 2017. Textual information was analyzed via natural language processing.

RESULTS. We outlined the main goals in complication analysis, highlighted the power of artificial intelligence to ground the definition of «complications in neurosurgery» scientifically, to study the spectrum of complications, to identify, and predict them, and to define related risk factors.

CONCLUSION. Modern artificial intelligence technologies have a significant potential for application in complications research in neurosurgery.

48-51 17
Abstract

Pulmonary embolism (PE) is one of the most dangerous but relatively rare and potentially preventable complications in neurosurgery. A reliable assessment of PE rate and risk factors in neurosurgery requires analyzing a significant number of cases accumulated over a long time.

PURPOSE OF THE STUDY: to evaluate the quality of information extraction about hospital PE after neurosurgical operations with a semi-automatic analysis of unstructured texts from the electronic health records of the FSAI «NMRC named after ac. N. N. Burdenko» of the ministry of health of Russia for a period of 18 years using artificial intelligence technologies.

MATERIALS AND METHODS: To accomplish our goal, we applied a set of technologies we developed using artificial intelligence (patent RU 2751993C 1). The textual medical records, initially typed in by doctors using the keyboard into the electronic health records system «E-med» of the FSAI «NMRC named after ac. N. N. Burdenko» of the ministry of health of Russia from 2000 to 2017 were analysed. Three independent experts (neurosurgeons) were involved to verify machine learning performance.

RESULTS. We analyzed 621 case histories that were most likely to contain information about PE. We observed moderate agreement (incomplete — in 32.4 % of cases) between 3 experts (Kappa Light coefficient = 0.568, p < 0.0001). Disagreements were resolved with the involvement of a third expert and the introduction of formal rules for texts labeling. The information extraction algorithm we proposed demonstrated good performance in detecting PE in electronic medical records (sensitivity = 0.996; specificity = 0.974; accuracy = 0.936; F1-score = 0.921).

CONCLUSION. minimization of the subjective factor using computer technologies improves the quality and reliability of retrospective studies over a huge set of medical records.

52-55 26
Abstract

Adverse events identification in clinical documents is necessary for retrospective clinical research and evaluating medical care safety and cost-effectiveness. Since adverse events are usually reported with free text in medical records, special technologies are required to extract information about them from thousands of medical records.

MATERIALS AND METHODS: We introduced a technology to extract information based on natural language processing (patent RU 2751993C 1). The method is grounded on preselecting a lexicon specific to a particular adverse event and deciphering its use in microcontexts. The textual medical records, initially typed in by doctors using the keyboard into the electronic health records system «E-med» of the FSAI «NMRC named after ac. N. N. Burdenko» of the ministry of health of Russia from 2000 to 2017 were analysed.

RESULTS. The technology we proposed enabled us to solve the task of paresis identification with high quality (sensitivity = 0,947, specificity = 0,965, accuracy = 0,961, F1-score = 0,926, ROC AUC = 0,956 [0,941; 0,969]). Optimization of the proposed method (using only nouns when screening a vocabulary) enabled to reduce the time for its implementation from 13 to 6 hours with no major loss in quality.

CONCLUSION. Natural language processing can improve the quality of information extraction from medical texts, which, in particular, can be successfully applied in neurosurgical safety research.

56-59 27
Abstract

Evaluation of the immediate results of treatment of patients with discogenic and vertebrogenic pain syndrome in terms of differentiated use of minimally invasive surgical techniques.

MATERIALS AND METHODS: The data of 101 patients with degenerative-dystrophic diseases of the lumbar spine accompanied by pain were analyzed. 29 (28.7%) patients underwent laser vaporization of the intervertebral disc, 72 (71.3%) patients underwent radiofrequency spinal denervation.

RESULTS. Positive outcomes after laser vaporization were noted in 27 patients, after radiofrequency destruction of the sinuvertebral nerve, a positive result was noted in 67 patients.

CONCLUSION. Differentiated use of minimally invasive puncture methods for the treatment of osteochondrosis of the spine and competent selection of patients for these procedures in most cases contribute to achieving a positive result.

60-66 36
Abstract

The present paper describes cases of simultaneous stenting after removal of tumors of the lateral ventricular triangle and the technique of stenting in the long-term follow-up period after removal of tumors of the ventricular triangle.

THE PURPOSE OF THE STUDY: to evaluate the effectiveness and safety of the use of stenting operations for the treatment of entrapped temporal horn.

MATERIALS AND METHODS: The analysis of 8 cases of surgical treatment of entrapped temporal horn by ventricular system stenting is presented.

RESULTS: Stenting applied in the postoperative period (as a method of treating formed hydrocephalus) had a positive clinical effect in 100 % of cases — regressed cerebral symptoms, stagnation on the fundus, speech disorders. For patients in whom stenting was used as a method of preventing the development of hydrocephalus, a positive result was also noted — there was no increase in the size of the ventricular system and no application was required.

67-72 24
Abstract

There are no certain data in the world literature indicating the timing of exactly when, after performing decompression and neurolysis in patients with tunnel compression neuropathies of the median and ulnar nerves, the performance of stimulation EMG is informative for analysis the results of surgical treatment.

PURPOSE OF THE STUDY. To determine the timing of stimulation EMG is informative for assessing the results of surgical treatment in patients with carpal tunnel syndrome and in patients with cubital tunnel syndrome.

MATERIALS AND METHODS. The results of surgical treatment of 31 patients with carpal tunnel syndrome and with cubital tunnel syndrome were analyzed in N.V. Sklifosovsky Research Institute for Emergency medicine. The analysis was carried out using the DASH, VAS, and Boston Quality of Life Questionnaires. Further, the obtained parameters were compared with the data of stimulation EMG performed on the 5th day after the operation, and compared with the preoperative data of scales, questionnaires, and the results of stimulation EMG.

CONCLUSIONS. Stimulation EMG to assess the results of surgical treatment on the 5th day after decompression and neurolysis of the median or ulnar nerve is inappropriate, despite the improvement in the quality of life of patients and a decrease in the level of pain, since soft tissue edema in the area of surgical intervention may persist, which significantly reduces the information content of the data obtained with stimulation EMG.

73-76 23
Abstract

Hypofractionated stereotactic radiosurgery is an effective method of treating brain metastases, if their size or localization do not allow for their single-fraction irradiation. Differences in treatment regimens and patient populations between studies make it difficult to compare and analyze the results.

THE PURPOSE OF THE STUDY: To evaluate the effectiveness of two-stage Gamma knife stereotactic radiosurgery of brain metastases from various cancers.

MATERIALS AND METHODS: retrospective analysis of the results of two-stage stereotactic radiosurgery of 124 intracranial metastases. Irradiation was carried out on Leksell Gamma Knife Perfexion and Icon installations. The median tumor volume was 11.06 cm3. The marginal dose in the first and second stages was in the range of 10–14 GY, the total focal dose varied from 20 to 28 GY. The interval between the stages was 14 days.

RESULTS. The average follow-up period was 9.4 months. Continued growth was registered in 14.3 % of patients, radiation complications in 4.8 %. Local control of BM at 6, 12 and 24 months was 94 %, 86 %, 83 %, respectively.

CONCLUSION. Two-stage hypofractive stereotactic radiosurgery can be considered as the method of choice in the treatment of a complex category of oncological patients with cerebral metastases in the presence of restrictions to perform single irradiation or microsurgical resection.

77-83 39
Abstract

The problem of assessing the risk of a second epileptic seizure after a first unprovoked epileptic seizure is relevant. Assessing the risk of a second seizure is a difficult task, since epilepsy is a disease characterized by a pathological persistent predisposition of the brain to repeated seizures for any reason. This article describes the results of a dynamic study of clinical and electroencephalographic data in patients with a first unprovoked epileptic seizure. We examined 130 patients using clinical and neurological examination, electroencephalographic examination, video-EEG monitoring with obligatory sleep study, magnetic resonance imaging of the brain according to a special epileptic protocol with targeted examination of epileptogenic structures. Predictors of recurrent epileptic seizures and the development of locally determined epilepsy in patients with a first unprovoked epileptic seizure were identified. The presence of the identified predictors should be taken into account when determining treatment tactics and timely prescription of specific drug antiepileptic therapy.

TARGET. To study the characteristics and electroencephalographic data in the dynamics of the disease in patients with the first unprovoked epileptic seizure.

MATERIALS AND METHODS. The examination was carried out in 130 patients with the first unprovoked epileptic seizure (76 men and 54 women). The majority of patients (more than 70 %) were between the ages of 18 and 40. The presence of PNEP was established on the basis of such criteria as the occurrence of a seizure without regard to current cerebral pathology, as well as acute and/or chronic encephalopathy of toxic or dysmetabolic origin; no history of diseases that are predictors of epilepsy; no gross cerebral structural changes on MRI. The study did not include persons with current cerebral pathology or the development of an epileptic syndrome; in the presence of an epileptic reaction or provoked seizures; individuals with a previously diagnosed epilepsy.

RESULTS. It was found that the examined patients with PNEP have a number of features of neurological symptoms: in the shortest possible time after PNEP, cerebral symptoms prevailed over focal ones with the presence of hypertensivehydrocephalic syndrome in most cases. In addition, vegetative-dystonic syndrome was often determined. In terms of 3 to 6 months, cerebral symptoms also prevailed, but at a less significant level than in the shortest period after PNEP. During the observation period from 6 months to 1–1.5 years, there was some increase in focal neurological symptoms with a predominance of pyramidal insufficiency of varying severity.

CONCLUSIONS. Thus, the negative dynamics in the form of the formation of a persistent focus of epileptiform activity according to EEG monitoring data and the presence of structural changes on MRI in patients with the first unprovoked epileptic seizure can be considered as a reliable predictor of the occurrence of recurrent epileptic seizures and the development of locally caused epilepsy, which must be taken into account when determination of therapeutic tactics and timely appointment of specific drug AEP therapy.

84-91 19
Abstract

This work is devoted to the study of the state of the autonomic nervous system in the perioperative period in neurosurgical patients by assessing the Ashner reflex and the Kerdo index.

OBJECTIVE: to study the dynamics of the Ashner reflex and the Kerdo index in neurosurgical patients under general anesthesia.

MATERIALS AND METHODS: The study included 45 patients who underwent a planned neurosurgical operation under general anesthesia, the patients were divided into three groups. The Ashner reflex and the Kerdo index were evaluated at six stages of the operation, and based on the data obtained, conclusions were drawn about the state of the autonomic nervous system.

RESULTS: All patients of the first group at the main stage of the operation showed signs of sympathicotonia, patients of the second group were divided between eutonia and sympathicotonia, patients of the third group were dominated by sympathicotonia. At the end of the operation, after awakening, the Ashner reflex was evoked, which was regarded as eutonia.

CONCLUSION: Under general anesthesia, it is possible to assess the state of the autonomic nervous system based on the preservation of the Ashner reflex. Depending on the method of anesthesia used, this indicator of autonomic nervous system reactivity is preserved to a greater or lesser extent.

92-97 26
Abstract

To date, the issue of neurorehabilitation of patients with neuropathies of the sciatic nerve resulting from a fracture of the pelvic bones has not been completely resolved. One of the solutions to this problem is to conduct a course of electrical stimulation using implanted electrodes.

PURPOSE OF THE STUDY: to develop and substantiate the indications for conducting a course of electrical stimulation in patients with sciatic nerve palsy due to trauma to the pelvic bones.

MATERIAL AND METHODS: minimally invasive surgery was performed on 26 patients. Depending on the initial neurological deficit associated with damage to the sciatic nerve, predominantly of the peroneal portion, from 1 to 6 courses of electrical stimulation were performed, 55 implantations of single-channel electrodes were analyzed. The dynamics of recovery of the sciatic nerve function in patients with the consequences of acetabular trauma was assessed.

RESULTS. When comparing the results of treatment depending on gender, it was not possible to establish statistically significant differences (p = 0.056). With an increase in muscle strength by 1 point, a decrease in the patient’s age by 3.4 ± 0.5 years and an increase in the number of hospitalizations by 0.6 times should be expected, the resulting model explains 10.5 % of the observed differences in the population. Depending on the start of treatment “before the course of electrical stimulation”, an increase in muscle strength by 1 point should be expected to increase “after the course of electrical stimulation” in 84.4 % of cases.

CONCLUSION. In the absence of indications for revision interventions aimed at decompression of the sciatic nerve, a course of direct epidural electrical stimulation using implanted single-channel electrodes should be preferred.

98-101 32
Abstract

The problem of diagnosing and treating patients with traumatic brain injury is an important social problem due to the high level of disability and mortality among the working population.

THE PURPOSE OF THE STUDY: to conduct a retrospective analysis of patients with traumatic intracranial hematomas who were treated in the neurosurgical departments of Ulyanovsk.

MATERIALS AND METHODS: The analysis of 2567 case histories of patients, 76 acts of forensic autopsy and 354 protocols of operations was carried out. Patients underwent CT scan of the head, neurological examination with an assessment of the level of consciousness according to the Glasgow Coma Scale.

RESULTS. Of 2567 people, traumatic intracranial hematomas were diagnosed in 306 (11.9 %) patients: 71.2 % of them were men. The main cause of craniocerebral injury was household injuries — 57.8 % of cases, then criminal injury — 29.1 % of cases, industrial injury — 3.3 % of cases, traffic accidents — 9.8 % of cases. In most cases, subdural hematomas were observed, which accounted for 39.5 % of cases, then epidural — 19.9 % of cases and intracerebral hematomas — 21.6 % of cases. According to the time factor, acute hematomas were more common — 75.4 %, then subacute — 14.4 %, chronic — 6.9 %, progressive — 3.3 %. At the time of hospitalization, 48.4 % of patients were in clear consciousness, 12.1 % of patients were in moderate stunning, 14.1 % of patients were in deep stunning, 9.8 % of patients were in stupor, and 10.1 % were in moderate coma. patient, in deep coma — 3.9 % of patients, in terminal coma — 1.6 % of patients. mortality in patients with traumatic intracranial hematomas was 19.9 %.

CONCLUSION: the analysis of the treatment of patients with traumatic intracranial hematomas shows the relevance of the problem due to the frequent traumatization of patients of working age. In the structure of intracranial hematomas, a special type of hematoma has been identified — progressive hematomas that require control in diagnosis and treatment. The problem of high mortality in patients with TBI accompanied by the presence of intracranial hematomas in the Ulyanovsk region is relevant and requires further study to minimize the main quality indicators in the provision of neurotraumatological care to patients.

102-104 33
Abstract

A significant amount of research devoted to the study of the correlation between intracranial hypertension (ICH) and changes in the optic nerve sheaths diameter (ONSD) made it possible to establish, on the one hand, possibility of using ONSD for diagnostic and prognostic purposes, and on the other hand, to identify number of limitations of this technique, such as variability of ONSD due to individual anatomical features of the structure of the eyeball and optic nerve. In connection with this observation, it is advisable to introduce parameter ONSD index — the ratio of the optic nerve sheath diameter to the eyeball diameter, which allows decrease the significance of individual differences.

MATERIALS AND METHODS: on the basis of the. Burdenko Neurosurgery Institute for the period from 2020 to 2021, a prospective single-center observational applied study was conducted, which included 21 patients (5 women and 16 men) with invasive ICP monitoring, of which 17 patients with severe (GCS<8 points) traumatic brain injury (TBI) and 4 patients after aneurysmal subarachnoid haemorrhage (aSAh) (hunt-hess 3–4). The evaluation of the ONSD index was carried out on the basis of the data of the incoming and repeated brain CT, performed with slices up to 1.25 mm thick, and was calculated as the ratio of the ONSD to the transverse eyeball diameter.><points) traumatic brain injury (TBI) and 4 patients after aneurysmal subarachnoid haemorrhage (ASAH) (hunt-hess 3–4). The evaluation of the ONSD index was carried out on the basis of the data of the incoming and repeated brain CT, performed with slices up to 1.25 mm thick, and was calculated as the ratio of the ONSD to the transverse eyeball diameter.

RESULTS. Evaluation of the obtained data using ROC analysis revealed the correlation between the increase in ICP (>20 mm hg) and the increase in the ONSD index and the indicators of the average ICP and median ICP for the first day of monitoring. There was also a correlation between the ONSD index and the maximum values of ICP for the first 48 hours of monitoring.

CONCLUSION. The results obtained reliably confirm the possibility of using the ONSD index parameter for prognostic and diagnostic purposes in patients with ICH syndrome.

105-107 19
Abstract

Improving the efficiency, diagnosis and treatment of neurological complications of cervical osteochondrosis is one of the most urgent problems. Considering that in the focus of cervical osteochondrosis, as a rule, several adjacent intervertebral discs are affected at different stages of the pathological process, each of which causes different pain sensations, the pain syndrome acquires a multicomponent character.

GOAL. To develop a more objective (than existing methods) method for assessing the intensity of pain in cervical osteochondrosis.

RESULTS. A detailed study of the data obtained using the proposed method for determining the intensity of pain in cervical osteochondrosis makes it possible to follow the dynamics of the disease, select and predict the most appropriate type or set of rehabilitation measures for further treatment, which improves treatment results and reduces the disability of patients.

108-111 52
Abstract

Morton’s neuroma is a benign space-occupying mass (not a true tumor) of the common plantar digital nerve, which most often occurs in the third intertarsal space. A pathologically altered intertarsal ligament of the foot leads to compression and ischemia of the nerve, which may be the pathogenesis of the development of Morton’s neuroma.

GOAL. To improve the results of surgical treatment of Morton’s neuroma.

RESULTS. Ultrasound of the plantar surface of the feet in all 30 (100 %) patients revealed Morton’s neuroma. All patients underwent surgical treatment. In the analysis of pain scale data, the median pain score was 7.0 points, which is in the range of intense pain (i. e., more than 50.0 % of patients experienced intense pain). Conducting a correlation analysis of data from a numerical rating scale for assessing pain and the maximum intraoperative and ultrasonic dimensions (length) of formations did not reveal a significant relationship (in both cases, rS = 0.1, P > 0.05).

112-116 28
Abstract

Venous system of the brain is a rare point of thrombosis, with a high risk of occurrence in young people. The detection of this pathology has increased in recent decades due to the improvement of neuroradiological methods. Risk factors for cerebral venous sinus thrombosis overlap with those for the other points of venous thromboembolism, but some of them can be specific to this anatomical region. In this article a case of idiopathic intracranial hypertension syndrome in a young female is discussed, the development of which was based on multiple thrombosis of the cerebral veins and intracranial sinuses, proved by mR-venography, which were induced by both thrombogenic genetic risk factors together with the use of oral contraceptives.

117-121 57
Abstract

In a multidisciplinary hospital, the combined treatment of profusely vascularized tumors is a justified means of preventing intra and postoperative complications, in particular bleeding. Preoperative embolization of cerebral arteries plays an important role as the first stage of surgical treatment. This procedure made it possible to facilitate the resection of the tumor and reduce the risk of intraoperative bleeding.

THE PURPOSE OF THE STUDY: to evaluate the effectiveness of preoperative embolization in patients with profusely vascularized brain tumors in a multidisciplinary hospital.

MATERIALS AND METHODS: On the basis of the N.V. Sklifosovsky Research Institute for Emergency medicine, 5 patients, taking into account the size of the meningioma, as well as its profusely vascularization according to cerebral angiography, underwent combined treatment in the form of microsurgical removal of a volume formation (meningioma) with preliminary endovascular shutdown of the branches of the external carotid artery feeding the tumor stroma.

RESULT: In 100 % of cases of combined treatment, there was minimal intraoperative bleeding. In the long-term period, an unfavorable outcome was not observed in these patients.

CONCLUSION: It is advisable to perform combined operations to remove profusely supplied, large and giant meningiomas in a multidisciplinary hospital, which has not only all modern neurosurgical equipment, but also an X-ray endovascular installation.

122-127 43
Abstract

This work is devoted to the analysis of the possibilities of a new technique (personalized endovascular superselective chemoembolization) in the treatment of patients with locally advanced forms of locally advanced forms of malignant neoplasms of the head and neck complicated by nosebleed. Based on the literature data, as well as our own clinical observations, conclusions have been drawn about the effectiveness of personalized endovascular superselective chemoembolization of malignant neoplasms of the head and neck complicated by nosebleeds in stopping and preventing these bleeds in the future.

FORPOZE OF THE STUDY: to increase the effectiveness of diagnosis and treatment of patients with locally advanced malignant endovascular hypervascularized tumors of the head and neck complicated by nosebleeds based on the introduction into clinical practice of a new technique — endovascular superselective chemoembolization of these neoplasms.

MATERIALS AND METHODS: to solve this problem, 93 cases of patients with locally advanced malignant hypervascularized tumors of the head and neck, complicated by nosebleeds, were studied on the basis of the introduction into clinical practice of a new technique — endovascular superselective chemoembolization of malignant hypervascularized tumors of the head and neck.

RESULTS. In 93 cases, endovascular superselective angiography and endovascular superselective chemoembolization of malignant neoplasms of the head and neck complicated by nosebleeds were performed. The embolization was a mixture of microparticles of hepaSphere 50–100 microns saturated with cytostatic — doxorubicin (50 mg). The main sources of recurrent nosebleeds were the following basins of the external carotid artery: in 46.2 % of cases, the basin (hereinafter referred to as «b») of the maxillary artery, in 37.6 % — b. ascending pharyngeal artery, in 8.6 % — occipital artery, in 5.4 % — carotid node, in 2.2 % — mixed pools of blood supply to the tumor (from the pools of the external carotid artery and internal carotid artery on one side or on both sides). The hemostatic effect was achieved in all 93 patients due to sequential endovascular superselective chemoembolization of the vascular bed of the tumor itself, and in the future nosebleeds did not occur in these patients.

CONCLUSION. The personalized method of endovascular superselective chemoembolization with doxyrubicin of tumors with locally widespread forms of malignant neoplasms of the head and neck complicated by nosebleeds developed and implemented in medical practice was the initial stage of the combined method of treatment of this disease. A good hemostatic effect was achieved in all 93 patients.

128-132 38
Abstract

In tumors of neuroectodermal origin, a high level of expression of disialoganglioside GD 2 is observed, while in normal tissues its expression level is significantly lower, which makes GD 2 a promising target for the diagnostics of malignant neoplasms.

PURPOSE OF THE STUDY: was to synthesize and characterize the physicochemical properties of a laboratory sample of antiGD 2-mAbs@SPIONs, prepared on the basis of superparamagnetic nanoparticles, and intended for the diagnostics of malignant neoplasms of brain tumors.

MATERIALS AND METHODS: Superparamagnetic iron oxide nanoparticles (SPIONs) coated with carboxymethyldextran were synthesized using the method of co-precipitation in an aqueous medium. They were then conjugated with antibodies against GD 2 labeled with a fluorescent dye (fluorescein-5-maleimide). Next, the anti-GD 2-mAbs@SPIONs conjugate was purified by dialysis.

The concentration of iron, coating (carboxymethyl-dextran) and protein (antibodies against GD 2) in the resulting nanosuspension was measured using the thiocyanate method, by quantifying the reaction of the polymer with an antron reagent and by the Bradford method, respectively. Using dynamic light scattering, data on the surface charge of conjugates were obtained, their hydrodynamic size and the nature of dispersion were established. The analysis of MR-contrasting properties was carried out using the MRI method of a phantom sample on an NMR spectrometer.

The interaction of the anti-GD 2-mAbs@SPIONs conjugate with cells of the U 251 line (human glioblastoma) was recorded using confocal microscopy.

RESULTS. A laboratory sample of superparamagnetic nanoparticles anti-GD 2-mAbs@SPIONs recognizing disialoganglioside GD 2 on the membrane surface of cancer cells was synthesized and characterized using physicochemical methods. A specific accumulation of the drug in glioblastoma cells has been shown in comparison with unconjugated nanoparticles.

CONCLUSION. The specificity of the accumulation of magnetic conjugate in tumor cells gives hope for the possibility of using anti-GD 2-mAbs@SPIONs in the diagnostics of malignant neoplasms of the central nervous system, however, further research is needed.

133-138 38
Abstract

Vascular complications are the main causes of mortality in vestibular schwannoma surgery.

PURPOSE OF THE STUDY: to analyze vascular complications in surgical treatment of large and giant vestibular schwannomas.

MATERIAL AND METHODS: over the past 10 years, 76 patients with large or giant vestibular schwannomas have been operated in the Neurosurgery Department of the Krasnoyarsk Regional Clinical hospital. Results.

RESULTS. Vascular complications were diagnosed in 19.7 % patients. Of these, hemorrhagic was observed in 3 (3.9 %), and ischemic in 12 (15.7 %) cases. hemorrhages were represented by two hematomas of the tumor bed and one case of pontine hemorrhage. Among ischemic complications, there were 2 cases of pontine ischemia and 10 varying cases of the cerebellum ischemia. Postoperative mortality in the group of large and giant tumors was 6.5 %.

CONCLUSION. Risk factors of vascular complications for patients with large and giant vestibular schwannomas are elderly age, brainstem pia mater lesion of the tumor and encasement of blood vessels. The basis of prophylaxis is an accurate assessment of the blood supply to tumor, condition of the blood vessels, intraoperative neurophysiological and postoperative clinical monitoring, as well as accurate and thorough dissection of the tumor capsule. In case of clinical manifestations of postoperative vascular complications, decompressive craniotomy of the posterior fossa is indicated, removal of the hematoma and, if necessary, the implantattion of external ventricular drainage.

139-144 81
Abstract

Restoration of the mimic muscles is one of the most difficult problems in reconstructive surgery.

PURPOSE OF THE STUDY: to evaluate the results of facial nerve neurotization performed at various times after removal of large and giant vestibular schwannomas.

MATERIAL AND METHODS: The study analyzed the results of reinnervation of the facial nerve in patients after removal of large and giant vestibular schwannomas. On the 10–14th day after the removal of the tumor, reinnervation of the facial nerve was performed on 4 patients, in the long-term period from 6 to 12 months — on 17 patients.

RESULTS. The best results were obtained with direct trigeminal reinnervation of the facial nerve, carried out as early as possible. In these patients, it is possible to achieve the function of facial muscles corresponding to the House-Brackmann II–III. The worst results were noted among patients who underwent neurotization within 11–12 months after removal of vestibular schwannoma. The function of facial muscles in these patients was recovered only to House-Brackmann IV–VI.

CONCLUSION. Normalization of the function of facial muscles is one of the primary tasks in patients after removal of large and giant vestibular schwannomas. The results of our study indicate the greatest effectiveness of reinnervating surgeries performed as early as possible. The main problem of reinnervating operations performed by the XI and XII cranial nerves were violations of the function of muscles innervated by donor nerves.

145-149 22
Abstract

Vascular spasm and delayed cerebral ischemia are the most common complications of aneurysmal subarachnoid hemorrhage (ASAH), which lead to clinical deterioration and increased mortality. mechanisms leading to the development of complications after rupture of cerebral aneurysms and ASAH, as well as their surgical treatment, have been studied actively recently.

PURPOSE OF THE STUDY: to assess the severity of clinical manifestations of ASAH and the quality of clipping of cerebral aneurysms, to study the indicators of the pro-antioxidant system, vasoregulatory metabolites, platelet aggregation in the patients’ blood in the pre- and postoperative periods.

MATERIALS AND METHODS: we examined 31 patients operated on the 8th (5; 10) day after cerebral aneurysm rupture and development of ASAH. The studies were performed at the time of admission of patients to the hospital, on the 2nd and 10th days after microsurgical clipping of the cerebral aneurysms. The severity of the condition was assessed using the Hunt-Hess, WFNS, NIHSS and Glasgow coma scales. An MRI study was performed to diagnose cerebral ischemia. We studied the indicators of the pro-, antioxidant system of the blood, the concentration of nitrates/ nitrites, angiotensin-converting enzyme, and platelet aggregation. The indicators of 26 healthy individuals were used for comparison.

RESULTS. There was no statistically significant difference in the severity of the condition according to the hunthess, WFNS, NIHSS, and GCS scales in patients, operated on the 8th (5; 10) day after cerebral aneurysm rupture and the development of ASAH before and after microsurgical clipping of the aneurysm neck. An increase in the concentration of secondary products of lipid peroxidation (p=0.002), a decrease in the activity of superoxide dismutase (p=0.003), an increase in the rate of platelet aggregation (p=0.004), a decrease in the concentrations of nitrates/nitrites (p˂0.001) and angiotensinconverting enzyme (p =0.037) relative to the norm were established before treatment. A decrease in the imbalance of the pro-, antioxidant system and vasoregulatory metabolites in the blood with an increase in the hyperaggregation ability of platelets (p=0.006) were revealed in patients on the 10th day after clipping.

CONCLUSION. The disorders of various severity in the pro-antioxidant state, concentrations of vasoregulatory metabolites, primary hemostasis in patients with cerebral aneurysm rupture were established before and after surgical treatment. This disorders can lead to increased thrombus formation in the cerebral vasculature, impaired microcirculation and development of the delayed cerebral ischemia.

150-152 33
Abstract

Оne of the significant limiting factors of rehabilitation of patients with chronic disorders of consciousness (DOC) is critically illness polyneuropathy (CIP) which leads to severe structural lesions of the striated muscles. Dystrophin protein is one of the structural membrane proteins of muscle fibers and carry the supporting, protective and trophic function of muscle fiber.

OBJECTIVE: To study changes in the dystrophin protein in skeletal muscle biopsies in patients with DOC and CIP.

MATERIALS AND METHODS: The results of an in 9 patients with chronic impaired consciousness, polyneuropathy of critical conditions are presented. The scope of the study was 28 biopsies, of which 10 were deltoid muscles, 10 were flounder muscles and 8 were calf muscles. Immunohistochemical study of the accumulation of dystrophin protein in the membrane of muscle fibers immunohistochemical reactions were performed using a primary antibody to dystrophin and a DBS imaging system according to standard protocols.

RESULTS: The results of an immunohistochemical study of the accumulation of dystrophin protein in the membrane of muscle fibers in 9 patients with chronic impaired consciousness, polyneuropathy of critical conditions are presented. A different degree of intensity of the accumulation of dystrophin protein in the sarcolemma, up to its disappearance, was noted. These changes were focal in nature.

CONCLUSION: Thus, atrophic changes in skeletal muscles in patients with polyneuropathy are accompanied by the disappearance of dystrophin from the sarcolemma, which predisposes to fatty degeneration of muscles. The results obtained can be used to develop measures aimed at restoring dystrophin and stabilizing sarcolemma.

153-159 39
Abstract

Cognitive impairment is a global medical and social problem, with a high prevalence in the population and a rapid increase in the incidence due to an increase in the number and life expectancy of older people. Currently, it is especially relevant to identify such causes of cognitive impairment as neurodegenerative and cerebrovascular diseases at the stage of mild cognitive impairment (MCI) and even preclinical stages. The most common types of predementia are amnestic mild cognitive impairment (aMCI) and subcortical vascular mild cognitive impairment (svMCI). The hippocampus plays an important role in the consolidation of information from short-term memory to long-term memory and consists of anatomically and functionally distinct subfields. however, at present, the features of atrophy of its subfields in MCI have not been studied enough. The aim of the study was to clarify the changes in the volumes of the hippocampus and its subfields using the example of MCI of various genesis in comparison with normal age-related aging. Three groups of 20 people were examined: patients with a MCI, patients with sv MCI and the control group. The paper analyzes the data of MRI morphometry of the hippocampal subfields in patients with aMCI and svMCI and compares them with normal age-related aging. Significant differences were found between the group of patients with aMCI and the control group, mainly in the volume of subiculum, presubiculum, molecular layer of the hippocampus, CA1 and CA4; between the group of patients with svMCI and the control group in the volume of subiculum, right presubiculum, molecular layer of the hippocampus, dentate gyrus and CA4. In contrast to svMCI, in aMCI, there is a significant decrease in the volume of the left subiculum by 21 %, the right subiculum, the left presubiculum and the molecular layer of the left hippocampus by 19 %, and the left CA4 by 17 %. The obtained data suggest that hippocampal subfields atrophy are determined already at the stages of aMCI and svMCI, and the distribution patterns of atrophy of the hippocampal subfields can be used for the differential diagnosis of MCI of various genesis.

160-166 59
Abstract

The new coronavirus infection caused by the SARS-CoV-2 virus has become one of the deadliest pandemics of the last century. It is now known that COVID-19 leads to microvascular and macrovascular pathophysiological changes, causing many extrapulmonary complications. They occur even against the background of adequately conducted etiotropic and pathogenetic therapy. This is associated with several factors: an imbalance in the synthesis of inflammatory, anti-inflammatory, immunoregulatory cytokines and chemokines, inflammatory markers, macrophage activation. So, in 2020, otolaryngologists, maxillofacial surgeons and neurosurgeons around the world faced a complication of COVID-19, manifested by the development of necrosis of the nasal mucosa, middle and lower turbinates, hard palate mucosa destruction of the walls of the maxillary, frontal sinuses, bottom orbit, frontal bones.

MATERIAL AND METhODS: In the clinic of the Department of Neurosurgery and cranio-facial surgery of the RMANPE — hospital named after F. I. Inozemtsev, 20 patients with osteomyelitis of the maxilla, zygomatic, and ethmoid bones were treated in 2021, 2022. Subsequently, osteomyelitis of the cranial bones was diagnosed in 2 patients. They required craniectomy with excision of osteomyelitic altered frontal, parietal and temporal bones.

RESULTS: Patients were discharged from the hospital without intracranial infection complications. Reconstructive interventions to restore the tightness of the cranial cavity are planned no earlier than 1 year after discharge from the hospital.

CONCLUSION: Complications after COVID-19 require careful analysis. The pathogenesis of the formation of osteomyelitis of the skull bones has not been fully elucidated, correction of conservative pathogenetic therapy in order to reduce purulent complications.

167-174 56
Abstract

Idiopathic hydrocephalus due to obstruction of the outlets of the IV ventricle is an extremely rare disease. Surgical treatment is represented by a variety methods: microsurgical, shunting and endoscopic, their combinations. microsurgical interventions are more damage, the development of endoscopic techniques make it quite justified to refuse microsurgery and difficult endoscopic interventions in favor of endoscopic third ventriculostomy.

POURPOSE OF THE STUDY: to evaluate the effectiveness of endoscopic third ventriculostomy in idiopathic hydrocephalus due to obstruction of the IV ventricle outlets.

MATERIAL AND METODS. From October 2011 to march 2021 at the Burdenko neurosurgical Institute 290 patients were operated. They met the criteria for adult idiopathic hydrocephalus: the onset of symptoms in adulthood and no indications for the etiology of hydrocephalus, as well as congenital hydrocephalus. In 18 (6,2 %) cases obstruction of the IV ventricles outlets was identify. The age of patients ranged from 26 to 74 years, averaged 47 ± 16.5 years, there were more women (61.1 %). The symptoms of the disease were headaches (77.8 %), gait disturbance (88.9 %), memory loss (72.2 %), dizziness (33 %), incoordination (27.8 %), dizziness (61.1 %), urine incontinence (27.8 %), faintings (16.6 %), hands tremor (11.1 %) The condition of patients before surgery was evaluated by the Kiefer and Rankin scales and amounted to 8,05 ± 4,34 (2–19) points and 2,6 ± 0,9 (1–5) points, respectively. Brain MRI of all patients was analyzed for different parts of cerebrospinal fluid system and changes of the position of anatomical structures.

RESULTS. Enlargement of the lateral and III ventricles was noted in all cases, enlargement of the IV ventricle in 88.8 %. The severity of the condition of the patients significantly depended on the sizes of the IV ventricle (p < 0.05) and didn’t depend on the sizes of the lateral and III ventricles. Compression of convexital subarachnoid spaces was recorded in 27.7 % of patients, and subarachnoid spaces of the posterior cranial fossa — in 72.2 %. Individually, these parameters didn’t affect the severity of the condition of the patients, but their simultaneous exposure significantly aggravated the symptoms (p < 0.05). The tonsils herniation was noted in 38.8 % cases. Standard endoscopic third ventriculostomy was performed in 83.5 % of patients. There were no complications or deaths. In 73.3 % of cases, after endoscopic surgery, there was a full recovery or near full recovery. In 26.7 % cases, hydrocephalus symptoms were regressed, but the condition of the patients was continued worse due to persistent herniation of the tonsils and progression of brainstem symptoms. They underwent microsurgical decompression of the craniovertebral junction. The average meaning the Kiefer and Rankin scales in follow-up was 2.4 ± 3.2 (0–9) and 0.9 ± 1.1 (0–4) points, respectively. There was a direct relationship between the disease history and the recovery of the patients (p < 0.05). Tonsils herniation gave significantly worse treatment results (p < 0.05). The improvement in the condition of patients was significantly associated with a decrease ventricles sizes, an enlargement of the convexital and basal subarachnoid spaces, normalization of the position of the premamillary membrane, and reposition of the cerebellar tonsils into the cranial cavity (p < 0.05).

CONCLUSIONS. Endoscopic third ventriculostomy in idiopathic hydrocephalus due to obstruction of the IV ventricle outlets is highly effective and can be used as the surgery of choice. Shunt surgery should be used as an alternative, if endoscopic surgery is impossible or ineffective. microsurgical decompression in such patients is indicated when the symptoms are getting worse due to the herniation of the cerebellar tonsils into the foramen magnum, although cerebrospinal fluid disorders were eliminated.

175-178 34
Abstract

The results of studies and treatment of 26 patients with echinococcosis of the spine, carried out in the period from 2017 to 2019, are presented.

THE PURPOSE OF THE STUDY: to conduct a comparative analysis of the surgical treatment of patients with spinal echinococcosis in the thoracic and lumbar regions during decompressive and decompressive-stabilizing operations.

MATERIAL AND METHODS. The intensity of pain syndrome (VAS scale), neurological condition (ASIA scale), radiological parameters characterizing the degree of spinal column deformity were studied.

RESULTS. A good result of treatment (group A) was observed in 17 (65.4 %) patients. Satisfactory (group B) treatment results were observed in 8 (30.8 %) patients. In 1 (3.8 %) case, a poor treatment result was obtained (group C). Analysis of neurological disorders in groups A and B in terms of the function of the lower extremities revealed an improvement of 1.46 ± 0.77 degrees on the ASIA / IMSOP scale. Regression of neurological disorders occurred in all 25 patients. A decrease in pain syndrome was noted by 4.35 ± 1.33 degrees on the VAS scale. In groups A and C, the decrease in the angle of local kyphosis was 11.87˚ ± 7.12˚. Better results were observed in the PCP (9.45 % ± 8.50 %) than in the PCDP (7.55 % ± 8.86 %).

CONCLUSION. Decompression of the spinal cord with removal of echinococcal cysts of the spinal canal, resection of vertebral bodies affected by echinococcosis reduces pain and reduces neurological disorders. Transpedicular stabilization allows you to restore the deformed axis of the spine.

CLINICAL CASES

179-182 29
Abstract

The formation of subarachnoid hematomas of the spinal cord is relatively rare. Among the possible causes are injuries, vascular pathologies, tumors, as well as violations of the hemostasis system. Clinical manifestations depend on the volume of the hematoma and vary from an asymptomatic course to the development of severe life threatening conditions. The article presents a case of treatment of a patient with subarachnoid hematoma of the spinal cord at the cervical level.

183-187 38
Abstract

Posttraumatic angiospasm is one of the complications of traumatic brain injury. The pathogenesis of traumatic angiospasm includes the occurrence of vasoconstriction of cerebral vessels as a result of a reaction to hemoglobin breakdown products (an inflammatory reaction in response to subarachnoid hemorrhage (SAH)), leading to cerebral edema, ischemia and intracranial hypertension, which may affect treatment tactics. however, at the moment there are no generally accepted recommendations for the treatment of this complication.

THE PURPOSE OF THE STUDY: to assess the need for transcranial duplex scanning (TCDS) in the preoperative period in patients with traumatic brain injury to determine the optimal tactics of surgical treatment.

MATERIALS AND METHODS: An analysis of the diagnosis and treatment of 34 victims with TBI who were at the N.V. Sklifosovsky Research Institute for Emergency medicine was carried out. All patients underwent brain CT and transcranial duplex scanning (TCDS). Surgery was performed in 9 patients. The victims who underwent surgical treatment were divided into 2 groups: In 3 out of 9 patients, TCDS was performed before surgery (group 1), in 6 out of 9 patients, TCDS was performed in the postoperative period (group 2).

RESULTS: Angiospasm was detected in 15 out of 34 (44 %) according to TCDS data. Angiospasm was detected in 2 out of 3 people on TCS performed before surgery. In patients who underwent TCS in the postoperative period, angiospasm was detected in 3 out of 6 patients. Surgery was not performed on 10 patients. Patients from group 1 underwent: 1 — decompressive cranial trepanation (DCTCH), 2 — bone-plastic cranial trepanation (CRTCH) (1 subsequently, repeated intervention with DCTCh was required due to the developed edema-ischemia on the background of angiospasm). Surgical tactics were applied to patients from group 2: 2 — DCTCH, 4 — CPTCH (2 subsequently required repeated intervention — DCTCH due to the developed edema-ischemia on the background of angiospasm). In the postoperative period, deaths were 4: 3 — after preventive CT, 1 — after CT with repeated intervention in the form of DCT due to the developed edemaischemia on the background of angiospasm.

CONCLUSION: Angiospasm is a significant factor in the development of edema and ischemia of the brain. It is necessary to monitor all victims with TBI, in order to improve the outcome of the disease.

188-196 27
Abstract

Despite modern advances in medicine, the number of patients with malignant neoplasms around the world continues to grow [1]. It is known that every year more than 12 million new cases are detected, of which 6 % are brain tumors. Brain lesions are in third place in terms of growth rates among all neoplasms [2, 3]. Often, patients with malignant processes, including the central nervous system and scalp, have difficulties in healing postoperative wounds. This is due to the presence of the oncological disease itself and the effects of radiation and chemotherapy on the body, which reduce immunity and contribute to the development of wound infection.

PURPOSE OF THE STUDY. To describe the clinical observations of patients with malignant tumors of the central nervous system (CNS) and the skin of the head and the complexity of the treatment of postoperative wounds in them.

MATERIALS AND METHODS. Three patients with malignant tumors of the brain and scalp and an unfavorable course of postoperative wound healing were observed in the neurosurgical department of the St. Petersburg State Budgetary healthcare Institution «Mariinsky City hospital». All of them underwent computed tomography (CT) and magnetic resonance imaging (MRI) with additional study protocols, one also underwent SPECT/CT with 99mTc-MIBI. Two patients underwent complex and combined treatment, one had only surgery. In all cases, against the background of poor healing of postoperative wounds, inflammatory changes in the brain developed with an outcome in an abscess.

RESULTS. A favorable course of the disease was observed in one patient who did not receive chemotherapy and radiation therapy. he was discharged in a satisfactory condition with signs of regression of a brain abscess. Two other patients with long-term, poorly healing, open postoperative wounds had a lethal outcome.

REVIEWS OF LITERATURE

197-203 212
Abstract

The review is devoted to the problem of infundibular dilatation (ID) of cerebral vessels and, first of all, the posterior communicating artery (PCA). Currently, there are no common views on this problem among neurosurgeons. It is believed that they are not dangerous and do not require dynamic monitoring. At the same time, a significant number of clinical cases and series of observations of direct ruptures of infundibular extensions and their transformation into aneurysms with subsequent rupture have been accumulated. In the review, the issues of diagnosing infundibular dilatation of the cerebral arteries and their difference from miliary aneurysms are considered. Particular attention is paid to the options for management of subarachnoid hemorrhage (SAH) in the absence of other vascular pathology.

DISCUSSION PAPERS

204-210 39
Abstract

Neurotrauma is one of the main causes of disability and death in the world, especially in young and middle-aged men. however, the mechanisms that mediate the survival and death of cells of the peripheral nervous system are still not fully understood. Therefore, studies of the cellular-molecular mechanisms of damage to the peripheral nervous system on model objects are relevant.

MATERIALS AND METHODS: This review focuses on the obtained date from the Laboratory of molecular Neurobiology, the Southern Federal University, plus initial Pubmed search (https://pubmed.ncbi.nlm.nih.gov/), including the unique characteristic and perspectives these axotomy models as an object for studying molecular and cellular changes caused by axotomy of the peripheral nervous system.

RESULTS. In our studies, we used three experimental models of neurotrauma in vertebrates and invertebrates: mechanoreceptor neurons (MRN) and ganglia of the crayfish ventral nerve cord (VNC), as well as the axotomized dorsal root ganglia (DRG) of the rat spinal cord, obtained by the sciatic nerve transection. Thus, the use of these models helps to clarify the complex mechanisms of different types of neurotrauma leading to the death of neurons and glial cells.

CONCLUSION. The acquired knowledge will underlie a theoretical background, which will help to better understand the fundamental mechanisms of survival and death of neurons and glial cells after nerve damage. The discovery of pathways of injury in neurons and glia of axotomized ganglia may identify new targets for the treatment of neurotrauma and its consequences.

НЕКРОЛОГИ



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