Pub Date : 2022-10-05DOI: 10.17650/1683-3295-2022-24-3-46-51
R. A. Kovalenko, Y. I. Ryumina, V. Cherebillo, V. A. Kashin
Background. Spinal epidural arachnoid cysts are the protrusion of the arachnoid membrane through an existing defect in the dural, functioning as a valve. Literature data on diagnosis and surgical treatment are presented by descriptions of clinical cases and there is no consensus on the optimal approach to solving this problem.Aim. To present a clinical case of surgical treatment of epidural arachnoid cyst type II of the thoracic and lumbar spine; to analyze methods of diagnosis and surgical treatment of such cysts.Materials and methods. All cases of diagnosis and treatment of spinal epidural arachnoid cysts in adults published in the PubMed search engine by 2021 have been analyzed. A clinical case of successful surgical treatment of an epidural arachnoid cyst of the thoracic and lumbar spine of type II on the basis of the Almazov National Medical Research Centre (Saint Petersburg, Russia) is presented.Results. Analysis of the published results of treatment of patients with epidural arachnoid cysts showed that the main task facing the surgeon is to identify and close the communication between the cyst and the subdural space. To accurately determine the localization of the dura mater defect and minimize operative access, many authors consider computed tomography myelography to be effective.Conclusion. Despite the variety of existing diagnostic methods, a specific and accurate way to visualize the defect has not been found to date. Based on the analysis of the literature, it can be said that the rarity of publications on this topic makes even individual reports relevant, and today there is no way to propose a specific strategy for the diagnosis and surgical treatment of such cysts.
{"title":"Surgical treatment of epidural arachnoid cyst type II of the thoracic and lumbar spine: case report","authors":"R. A. Kovalenko, Y. I. Ryumina, V. Cherebillo, V. A. Kashin","doi":"10.17650/1683-3295-2022-24-3-46-51","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-3-46-51","url":null,"abstract":"Background. Spinal epidural arachnoid cysts are the protrusion of the arachnoid membrane through an existing defect in the dural, functioning as a valve. Literature data on diagnosis and surgical treatment are presented by descriptions of clinical cases and there is no consensus on the optimal approach to solving this problem.Aim. To present a clinical case of surgical treatment of epidural arachnoid cyst type II of the thoracic and lumbar spine; to analyze methods of diagnosis and surgical treatment of such cysts.Materials and methods. All cases of diagnosis and treatment of spinal epidural arachnoid cysts in adults published in the PubMed search engine by 2021 have been analyzed. A clinical case of successful surgical treatment of an epidural arachnoid cyst of the thoracic and lumbar spine of type II on the basis of the Almazov National Medical Research Centre (Saint Petersburg, Russia) is presented.Results. Analysis of the published results of treatment of patients with epidural arachnoid cysts showed that the main task facing the surgeon is to identify and close the communication between the cyst and the subdural space. To accurately determine the localization of the dura mater defect and minimize operative access, many authors consider computed tomography myelography to be effective.Conclusion. Despite the variety of existing diagnostic methods, a specific and accurate way to visualize the defect has not been found to date. Based on the analysis of the literature, it can be said that the rarity of publications on this topic makes even individual reports relevant, and today there is no way to propose a specific strategy for the diagnosis and surgical treatment of such cysts.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126013354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-13DOI: 10.17650/1683-3295-2022-24-2-94-104
D. E. Zakondyrin, A. Grin
Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.
{"title":"Spinal tumors: literature review","authors":"D. E. Zakondyrin, A. Grin","doi":"10.17650/1683-3295-2022-24-2-94-104","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-94-104","url":null,"abstract":"Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114768326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-13DOI: 10.17650/1683-3295-2022-24-2-113-121
D. Dolotova, E. Blagosklonova, G. R. Ramazanov, I. Arkhipov, S. Petrikov, A. Gavrilov
In ischemic stroke, the condition of cerebral collateral circulation is one of the key factors determining the outcome. Digital subtraction angiography is considered the gold standard of evaluation of cerebral collateral circulation. However, computed tomography angiography is the most widely used method characterized by high level of conformity with subtraction angiography. Currently, several scales of visual evaluation of collateral circulation development in images obtained by computed tomography angiography are used. The scales describe the territory of stroke-associated cerebral artery, as well as details of various areas of the territory. The association between the score and severity of neurological deficit and volume of cerebral ischemia was demonstrated in numerous studies. However, consensus on the most reliable method of description of cerebral collateral status has not been reached. Use of modern methods of processing of medical images and artificial intelligence allowed to make a significant step towards automatization of collateral status evaluation with such benefits as high processing speed and resistance to subjective opinion. Despite low number of studies on this subject, implementation of automated solutions has already showed its effectiveness. In this review, scales for manual evaluation of cerebral collateral status are considered, their reliability is described, and current approaches to automated evaluation of collateral circulation in ischemic stroke are presented.
{"title":"Evaluation of cerebral collateral status using computed tomography angiography in ischemic stroke: review of manual and automated methods","authors":"D. Dolotova, E. Blagosklonova, G. R. Ramazanov, I. Arkhipov, S. Petrikov, A. Gavrilov","doi":"10.17650/1683-3295-2022-24-2-113-121","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-113-121","url":null,"abstract":"In ischemic stroke, the condition of cerebral collateral circulation is one of the key factors determining the outcome. Digital subtraction angiography is considered the gold standard of evaluation of cerebral collateral circulation. However, computed tomography angiography is the most widely used method characterized by high level of conformity with subtraction angiography. Currently, several scales of visual evaluation of collateral circulation development in images obtained by computed tomography angiography are used. The scales describe the territory of stroke-associated cerebral artery, as well as details of various areas of the territory. The association between the score and severity of neurological deficit and volume of cerebral ischemia was demonstrated in numerous studies. However, consensus on the most reliable method of description of cerebral collateral status has not been reached. Use of modern methods of processing of medical images and artificial intelligence allowed to make a significant step towards automatization of collateral status evaluation with such benefits as high processing speed and resistance to subjective opinion. Despite low number of studies on this subject, implementation of automated solutions has already showed its effectiveness. In this review, scales for manual evaluation of cerebral collateral status are considered, their reliability is described, and current approaches to automated evaluation of collateral circulation in ischemic stroke are presented.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"97 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133847076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-13DOI: 10.17650/1683-3295-2022-24-2-105-112
A. Dmitriev, M. Sinkin, V. Dashyan
Monitoring of motor evoked potentials in surgery of supratentorial tumors estimates integrity of cortical motor centers and subcortical pathways. Violation of motor evoked potentials takes place in mechanical injury or ischemia of motor neurons. Decrease of amplitude of motor evoked potentials more than 50 % is predictor of permanent neurological deficit.Cortical mapping gives a possibility to discover eloquent brain areas before their resection. To reveal motor centers activating stimulation is applied, to find out speech or sensory areas – the inhibiting one. Positive brain mapping allows to exclude technical fault in selection of stimulation threshold but it demands a wide craniotomy. Negative mapping is more widespread, gives opportunity to use tailored craniotomy that reduces surgical injury and duration of operation. One of the most valuable factors in cortical and subcortical brain mapping is the stimulation threshold. With monopolar «train» stimulation current 1 mA spreads into approximately 1 mm. The safe value of current intensity during tumor resection in eloquent areas is 3–5 mA.Monopolar stimulation demands less time for location of eloquent brain areas, it is as accurate as the bipolar mapping and more rarely leads to intraoperative seizures. Combination of monopolar stimulator with aspirator gives opportunity to continuously allocate pyramidal tract in tumor resection.
{"title":"Intraoperative neuromonitoring in surgery of supratentorial brain tumors. Part 1. Assessment of motor conductivity","authors":"A. Dmitriev, M. Sinkin, V. Dashyan","doi":"10.17650/1683-3295-2022-24-2-105-112","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-105-112","url":null,"abstract":"Monitoring of motor evoked potentials in surgery of supratentorial tumors estimates integrity of cortical motor centers and subcortical pathways. Violation of motor evoked potentials takes place in mechanical injury or ischemia of motor neurons. Decrease of amplitude of motor evoked potentials more than 50 % is predictor of permanent neurological deficit.Cortical mapping gives a possibility to discover eloquent brain areas before their resection. To reveal motor centers activating stimulation is applied, to find out speech or sensory areas – the inhibiting one. Positive brain mapping allows to exclude technical fault in selection of stimulation threshold but it demands a wide craniotomy. Negative mapping is more widespread, gives opportunity to use tailored craniotomy that reduces surgical injury and duration of operation. One of the most valuable factors in cortical and subcortical brain mapping is the stimulation threshold. With monopolar «train» stimulation current 1 mA spreads into approximately 1 mm. The safe value of current intensity during tumor resection in eloquent areas is 3–5 mA.Monopolar stimulation demands less time for location of eloquent brain areas, it is as accurate as the bipolar mapping and more rarely leads to intraoperative seizures. Combination of monopolar stimulator with aspirator gives opportunity to continuously allocate pyramidal tract in tumor resection.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"250 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115681340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-13DOI: 10.17650/1683-3295-2022-24-2-78-93
A. Ermolaev, A. Yarikov, A. Aleynik, A. Dubskikh, I. Smirnov, O. Perlmutter, A. Sosnin, A. M. Ermolaeva, A. Fraerman
Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.
{"title":"Surgical methods in management of metastatic spinal cord lesions","authors":"A. Ermolaev, A. Yarikov, A. Aleynik, A. Dubskikh, I. Smirnov, O. Perlmutter, A. Sosnin, A. M. Ermolaeva, A. Fraerman","doi":"10.17650/1683-3295-2022-24-2-78-93","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-78-93","url":null,"abstract":"Malignant neoplasms remain the leading cause of death worldwide. The spine is a target for metastasis more often than other skeletal bones. This article details the principles of diagnosis, treatment, and the clinical picture of secondarylesions of the spinal column. The causes of pain syndrome in cancerous lesions of the spine are reviewed: compression of nerve structures, pathological fractures, spinal instability, lytic foci and paraneoplastic pain syndrome. The causes and patterns of each type of pain syndrome are described in detail. The article presents the scales used to predict the life expectancy of these patients: Tokuhashi, Tomita and Bauer. The effectiveness of these scales is compared. The selection criteria for surgical treatment of patients with metastatic lesions of the spine are described in detail. Modern methods of surgical treatment of secondary lesions of the spinal column are presented: palliative, subtotal, total (enblock resections). The indications and contraindications for each type of surgical treatment are described. Methods of intraoperative hemostasis are described, with the special attention given to preoperative tumor embolization. The errors and complications of this technique are described in detail. The correlation dependence of intraoperative blood loss volume on the embolization terms is presented. Modern trends in the development of surgical methods in metastatic spinal tumors are described in conclusion.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132946068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.17650/1683-3295-2022-24-2-72-77
Gennadii Gennadievich Bulyshchenko, A. Gayvoronsky, P. S. Liev, M. V. Kuznetsov, D. V. Svistov
A clinical example of surgical treatment of a patient with long-term consequences of a gunshot blind non-penetrating wound of the lumbar spine received 15 years ago is presented. The indication for performing surgical intervention was the development of recurrent retroperitoneal phlegmon in the last year and a half against the background of the presence of a foreign body (bullet) in the interbody gap L1–L2. In the “cold” period of the inflammatory process, the least invasive operation was performed. The article describes the course of percutaneous transforaminal endoscopic removal of a foreign body, and demonstrates the possibilities of such access. The above clinical observation indicates that the method of percutaneous transforaminal endoscopic surgery may not be limited in its indications only to degenerative-dystrophic diseases of the spine.
{"title":"Percutaneous transforaminal endoscopic removal of a foreign body of the lumbar spine","authors":"Gennadii Gennadievich Bulyshchenko, A. Gayvoronsky, P. S. Liev, M. V. Kuznetsov, D. V. Svistov","doi":"10.17650/1683-3295-2022-24-2-72-77","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-72-77","url":null,"abstract":"A clinical example of surgical treatment of a patient with long-term consequences of a gunshot blind non-penetrating wound of the lumbar spine received 15 years ago is presented. The indication for performing surgical intervention was the development of recurrent retroperitoneal phlegmon in the last year and a half against the background of the presence of a foreign body (bullet) in the interbody gap L1–L2. In the “cold” period of the inflammatory process, the least invasive operation was performed. The article describes the course of percutaneous transforaminal endoscopic removal of a foreign body, and demonstrates the possibilities of such access. The above clinical observation indicates that the method of percutaneous transforaminal endoscopic surgery may not be limited in its indications only to degenerative-dystrophic diseases of the spine.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"225 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124779028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.17650/1683-3295-2022-24-2-62-65
S. Apostolakis, A. Karagianni, I. Mylonakis, K. Vlachos
Introduction. Arachnoid cysts are benign lesions comprising about 1 % of all intracranial space occupying lesions. The majority are asymptomatic, while surgical intervention, consisting of fenestration, is suggested in the presence of mass phenomena.The aim of the study – to present the case of a patient with arachnoid cysts in the cerebellopontine angle and its treatment.Materials and methods. A 53‑years old female patient was referred to our Department of Neurosurgery for the surgical management of a cerebellopontine angle mass. The patient reported tingling sensation and causalgia of her left hemiface, dysarthria, hoarseness, difficulty swallowing solid food and liquids, tinnitus and pain distributed along the ophthalmic branch of the trigeminal nerve.Results. The patient was subjected to retrosigmoid craniotomy with fenestration of the cyst and concurrent placement of a Torkildsen shunt. No complete resection of the capsule of the cyst was attempted, due to its tight adhesions to the adjacent structures. Postoperatively, there was an improvement in the dysarthria and swallowing of the patient.Conclusions. Cerebellopontine angle cystic lesions while histologically benign, may become clinically apparent due to compression of adjacent structures. Simple fenestration of the cyst may be sufficient for the remission of symptoms.
{"title":"Mass phenomena from a cerebellopontine angle arachnoid cyst: case report","authors":"S. Apostolakis, A. Karagianni, I. Mylonakis, K. Vlachos","doi":"10.17650/1683-3295-2022-24-2-62-65","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-62-65","url":null,"abstract":"Introduction. Arachnoid cysts are benign lesions comprising about 1 % of all intracranial space occupying lesions. The majority are asymptomatic, while surgical intervention, consisting of fenestration, is suggested in the presence of mass phenomena.The aim of the study – to present the case of a patient with arachnoid cysts in the cerebellopontine angle and its treatment.Materials and methods. A 53‑years old female patient was referred to our Department of Neurosurgery for the surgical management of a cerebellopontine angle mass. The patient reported tingling sensation and causalgia of her left hemiface, dysarthria, hoarseness, difficulty swallowing solid food and liquids, tinnitus and pain distributed along the ophthalmic branch of the trigeminal nerve.Results. The patient was subjected to retrosigmoid craniotomy with fenestration of the cyst and concurrent placement of a Torkildsen shunt. No complete resection of the capsule of the cyst was attempted, due to its tight adhesions to the adjacent structures. Postoperatively, there was an improvement in the dysarthria and swallowing of the patient.Conclusions. Cerebellopontine angle cystic lesions while histologically benign, may become clinically apparent due to compression of adjacent structures. Simple fenestration of the cyst may be sufficient for the remission of symptoms.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125537166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.17650/1683-3295-2022-24-2-66-71
S. Ilyalov, A. M. Parshunina, K. M. Kvashnin, Ksenia Medvedeva, A. Baulin, O. Lepilina
Introduction. Currently, one of the effective methods of treatment of intracranial metastases is stereotactic radiosurgery. The main factors limiting its use are the size (volume) of the tumor or the location of the metastasis in critical proximity to radiosensitive brain structures, such as the optic pathways, thalamus, brain stem, due to the high risk of developing local radiation necrosis. To reduce the risk of adverse radiation effects, hypofractionated radiotherapy by linac or staged Gamma Knife radiosurgery is used. However, large brain metastases that cause dislocation of the brain midline structures are traditionally considered an object for surgical excision, the main purpose of which is to eliminate the mass effect caused by the tumor.The objective of the publication: to demonstrate a case of successful application of staged Gamma Knife radiosurgery of large brain metastases accompanied by brain compression and dislocation.Materials and methods. Patient, 38‑year-old, with right-sided hemiplegia (0 score) and large (Ø = 3 cm, V = 12.9 cm3) breast cancer metastasis in the deep site of the left hemisphere, accompanied by severe perifocal edema and braindislocation (midline shift up to 15 mm). The treatment was carried out by Gamma Knife in two stages with an interval of 1.5 months.Results. As a result, not only a complete regression both of the perifocal edema and midline shift were noted, but also a significant decrease of the tumor volume and dramatical improvement in the patient’s neurological status already in the interval between the stages of radiosurgery: restoration of active movements in the right limbs (up to 4 score).Conclusion. This case demonstrates the possibility of effective and safe non-invasive treatment of large brain metastases accompanied by brain compression and dislocation, which makes it possible to achieve regression of the mass effect and improve the neurological quality of life of cancer patients.
介绍。目前，治疗颅内转移瘤的有效方法之一是立体定向放射手术。限制其使用的主要因素是肿瘤的大小(体积)或转移的位置靠近辐射敏感的脑结构，如视神经通路、丘脑、脑干，因为发生局部辐射坏死的风险很高。为了减少不良辐射影响的风险，使用直线加速器或分期伽玛刀放射手术进行低分割放疗。然而，导致脑中线结构脱位的大型脑转移瘤传统上被认为是手术切除的对象，其主要目的是消除肿瘤引起的肿块效应。该出版物的目的是:展示一个成功应用分期伽玛刀放射治疗伴有脑压迫和脱位的大面积脑转移的病例。材料和方法。患者，38岁，右侧偏瘫(0分)，左半球深部大面积(Ø = 3cm, V = 12.9 cm3)乳腺癌转移，伴有严重的焦周水肿和脑脱位(中线移位达15mm)。伽玛刀治疗分两个阶段进行，间隔1.5个月。结果，不仅焦点周围水肿和中线移位完全消退，而且肿瘤体积显著减小，患者神经系统状态显著改善，在放射手术阶段之间，恢复了右侧肢体的主动运动(高达4分)。本病例证明了对大面积脑转移伴脑压迫脱位的有效、安全的无创治疗的可能性，使肿块效应的消退和肿瘤患者神经系统生活质量的提高成为可能。
{"title":"Staged radiosurgery of large brain metastasis with mass effect and brain dislocation: case report","authors":"S. Ilyalov, A. M. Parshunina, K. M. Kvashnin, Ksenia Medvedeva, A. Baulin, O. Lepilina","doi":"10.17650/1683-3295-2022-24-2-66-71","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-66-71","url":null,"abstract":"Introduction. Currently, one of the effective methods of treatment of intracranial metastases is stereotactic radiosurgery. The main factors limiting its use are the size (volume) of the tumor or the location of the metastasis in critical proximity to radiosensitive brain structures, such as the optic pathways, thalamus, brain stem, due to the high risk of developing local radiation necrosis. To reduce the risk of adverse radiation effects, hypofractionated radiotherapy by linac or staged Gamma Knife radiosurgery is used. However, large brain metastases that cause dislocation of the brain midline structures are traditionally considered an object for surgical excision, the main purpose of which is to eliminate the mass effect caused by the tumor.The objective of the publication: to demonstrate a case of successful application of staged Gamma Knife radiosurgery of large brain metastases accompanied by brain compression and dislocation.Materials and methods. Patient, 38‑year-old, with right-sided hemiplegia (0 score) and large (Ø = 3 cm, V = 12.9 cm3) breast cancer metastasis in the deep site of the left hemisphere, accompanied by severe perifocal edema and braindislocation (midline shift up to 15 mm). The treatment was carried out by Gamma Knife in two stages with an interval of 1.5 months.Results. As a result, not only a complete regression both of the perifocal edema and midline shift were noted, but also a significant decrease of the tumor volume and dramatical improvement in the patient’s neurological status already in the interval between the stages of radiosurgery: restoration of active movements in the right limbs (up to 4 score).Conclusion. This case demonstrates the possibility of effective and safe non-invasive treatment of large brain metastases accompanied by brain compression and dislocation, which makes it possible to achieve regression of the mass effect and improve the neurological quality of life of cancer patients.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116705056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.17650/1683-3295-2022-24-2-54-61
A. G. Gavrilov, D. Chelushkin, Ya. A. Latyshev, M. Ryzhova, T. Panina
Ependymoma is a brain tumor accounting for 1.9 % of all benign brain tumors and 3.1 % of glial tumors and 2–9 % of all neuroepithelial tumors. Approximately one third of intracranial ependymal tumors are supratentorial. They may be attached to the ependymal walls of the III ventricle and lateral ventricles or may be sited in the white matter without direct connection to the ventricular system pressing the adjacent cortex. In very rare cases ependymomas may lie cortically with blood supply from the dura – so-called «cortical» ependymomas.Posterior fossa ependymomas are more common in pediatric population with mean age of 6 years, whereas supratentorial ependymomas manifest in adults. In adults Grade III anaplastic ependymomas are most commonly seen.These tumors have no specific features and clinical manifestations of extraventricular anaplastic ependymomas may vary greatly depending on localization and size of the tumor.Supratentorial anaplastic ependymomas have no specific neuroimaging features either. Tumors are often hypo- and isointense in T1 and iso- or hyperintense in T2 sequence, Gd -inhancement is variable.Ependymomas are considered to be non-invasive and to have a strict border with brain tissue thus leading to clinical manifestations because of mass-effect.Surgical resection is the main treatment option for ependymoma. Patients with local Grade II tumor recurrence and patients with Grade III ependymomas should under go radiotherapy on the tumor r esection cavity.We present a rare case of a supratentorial extraventricular anaplastic ependymoma. A 21‑year-old female presented to the clinic with paresthesia and numbness in right hand, right half of lower lip and astereognosis. The magnetic resonance imaging of the brain showed a mass lesion in left fronto-parietal region. At 10.10.2017 surgery was performed and tumor was resected. Histological findings matched with features of anaplastic ependimoma, WHO Grade III. There was no tumor progression during 3 months after surgery.
{"title":"A rare case of the supratentorial extraventricular anaplastic ependymoma. Case report and literature review","authors":"A. G. Gavrilov, D. Chelushkin, Ya. A. Latyshev, M. Ryzhova, T. Panina","doi":"10.17650/1683-3295-2022-24-2-54-61","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-54-61","url":null,"abstract":"Ependymoma is a brain tumor accounting for 1.9 % of all benign brain tumors and 3.1 % of glial tumors and 2–9 % of all neuroepithelial tumors. Approximately one third of intracranial ependymal tumors are supratentorial. They may be attached to the ependymal walls of the III ventricle and lateral ventricles or may be sited in the white matter without direct connection to the ventricular system pressing the adjacent cortex. In very rare cases ependymomas may lie cortically with blood supply from the dura – so-called «cortical» ependymomas.Posterior fossa ependymomas are more common in pediatric population with mean age of 6 years, whereas supratentorial ependymomas manifest in adults. In adults Grade III anaplastic ependymomas are most commonly seen.These tumors have no specific features and clinical manifestations of extraventricular anaplastic ependymomas may vary greatly depending on localization and size of the tumor.Supratentorial anaplastic ependymomas have no specific neuroimaging features either. Tumors are often hypo- and isointense in T1 and iso- or hyperintense in T2 sequence, Gd -inhancement is variable.Ependymomas are considered to be non-invasive and to have a strict border with brain tissue thus leading to clinical manifestations because of mass-effect.Surgical resection is the main treatment option for ependymoma. Patients with local Grade II tumor recurrence and patients with Grade III ependymomas should under go radiotherapy on the tumor r esection cavity.We present a rare case of a supratentorial extraventricular anaplastic ependymoma. A 21‑year-old female presented to the clinic with paresthesia and numbness in right hand, right half of lower lip and astereognosis. The magnetic resonance imaging of the brain showed a mass lesion in left fronto-parietal region. At 10.10.2017 surgery was performed and tumor was resected. Histological findings matched with features of anaplastic ependimoma, WHO Grade III. There was no tumor progression during 3 months after surgery.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117131376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-10DOI: 10.17650/1683-3295-2022-24-2-35-42
A. Martikyan, A. Grin, A. Talypov, A. Kordonskiy, I. Lvov, O. Levina, A. Prirodov
Background. The dura mater tear are quite common in patients with thoracic and lumbar fractures. Prevention and management of cerebrospinal fluid leakage and sealing of the dura mater suture is an important stage in the treatment of such patients.Objective: to find an optimal surgical tactics for patients with fractures of the thoracic and lumbar spine and dura mater tear.Materials and methods. This study included 167 patients operated on for fractures of the thoracic and lumbar spine with concomitant traumatic spinal canal stenosis. We analyzed their clinical data and results of instrumental examination. All patients underwent laminectomy at the level of their fractures and transpedicular fixation. The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm2. Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm2) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). In 9 patients (16.4 %), the integrity of dura mater was restored without suturing (the «sandwich»-sealing method) (mean size of the dura mater defect 5.0 ± 2.6 mm2). Twenty-one patients had additional sealing of dura mater suture using bioglue.Postoperative wound cerebrospinal fluid leakage was registered in 5 out of 55 patients from the main group. Cerebrospinal fluid leakage was most common in patients who had undergone dura mater repair with implants (23.1 %), while those who had undergone direct dura mater suturing were less likely to develop it (6.1 %). No cerebrospinal fluid leakage was observed in patients with small defects (≤3 mm2) or in those whose dural tears were located at the nerve root cuffs. Patients with postoperative cerebrospinal fluid leakage had no additional sealing of dura mater suture using bioglue.Postoperative wound infection was registered in 4 (7.3 %) patients from the main group and 6 (5.4 %) patients from the control group.Conclusion. Sealing of dura mater sutures with glue compositions is an effective method to prevent postoperative cerebrospinal fluid leakage. Sealing of dura mater sutures with a collagen sponge does not prevent wound cerebrospinal fluid leakage.
{"title":"Treatment strategy for patients with thoracic and lumbar spine fractures with dura mater tear","authors":"A. Martikyan, A. Grin, A. Talypov, A. Kordonskiy, I. Lvov, O. Levina, A. Prirodov","doi":"10.17650/1683-3295-2022-24-2-35-42","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-2-35-42","url":null,"abstract":"Background. The dura mater tear are quite common in patients with thoracic and lumbar fractures. Prevention and management of cerebrospinal fluid leakage and sealing of the dura mater suture is an important stage in the treatment of such patients.Objective: to find an optimal surgical tactics for patients with fractures of the thoracic and lumbar spine and dura mater tear.Materials and methods. This study included 167 patients operated on for fractures of the thoracic and lumbar spine with concomitant traumatic spinal canal stenosis. We analyzed their clinical data and results of instrumental examination. All patients underwent laminectomy at the level of their fractures and transpedicular fixation. The main group included 55 patients with dura mater tear, whereas the control group comprised 112 patients without dura mater tear.Results. Dura mater tear was found in 32.9 % of patients with fractures of the thoracic and lumbar spine. Of them, 21.8 % had compression of the spinal cord or nerve roots at the sites of dura mater tear. This fact should be taken into account when performing decompression and the reduction maneuver to prevent additional injuries to the neural structures. Thirty-three (60.0 %) patients underwent direct suturing aimed to restore the dura mater integrity. Their mean size of the dura mater tear was 13.2 ± 7.4 mm2. Thirteen patients (23.6 %) with larger dural tear (27.5 ± 6.3 mm2) underwent their repair using either a fragment of dura mater from a deceased donor (n = 2), Reperen implants (n = 5), or Durepair patches (n = 6). In 9 patients (16.4 %), the integrity of dura mater was restored without suturing (the «sandwich»-sealing method) (mean size of the dura mater defect 5.0 ± 2.6 mm2). Twenty-one patients had additional sealing of dura mater suture using bioglue.Postoperative wound cerebrospinal fluid leakage was registered in 5 out of 55 patients from the main group. Cerebrospinal fluid leakage was most common in patients who had undergone dura mater repair with implants (23.1 %), while those who had undergone direct dura mater suturing were less likely to develop it (6.1 %). No cerebrospinal fluid leakage was observed in patients with small defects (≤3 mm2) or in those whose dural tears were located at the nerve root cuffs. Patients with postoperative cerebrospinal fluid leakage had no additional sealing of dura mater suture using bioglue.Postoperative wound infection was registered in 4 (7.3 %) patients from the main group and 6 (5.4 %) patients from the control group.Conclusion. Sealing of dura mater sutures with glue compositions is an effective method to prevent postoperative cerebrospinal fluid leakage. Sealing of dura mater sutures with a collagen sponge does not prevent wound cerebrospinal fluid leakage.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129667505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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