Pub Date : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-76-82
A. Bykanov, D. Pitskhelauri, M. A. Kirushin, O.A. Rastvorova, T. R. Zagidullin
Background. Physiological hand tremor is one of significant problems in microsurgical technique. One careless movement can cause damage to the neighboring structures and consequently worsen a patient’s condition. Therefore, the problem of reducing hand tremor remains relevant.Aim. To determine the effect of microsurgeon’s pose, duration of operation on the accuracy of surgical action and level of microsurgical hand tremor.Materials and methods. The study included 14 neurosurgery residents satisfying inclusion criteria. For evaluation and simulation of microsurgical action, validated and developed by the study authors devices for testing and surgical microscope Carl Zeiss were used. The experimental results were compared using univariate analysis. The differences were considered statistically significant at p <0.05.Results. Surgeon’s pose standing / sitting did not affect spatial accuracy of surgical action and the level of microsurgical hand tremor. However, statistically significant changes in hand tremor were observed both in standing and sitting positions with increased time of microsurgical action.Conclusion. The choice between sitting or standing pose for microsurgical operation is not a factor significantly affecting microsurgeon’s spatial accuracy of movement and hand tremor. Duration of surgical intervention affects the level of microsurgical hand tremor.
{"title":"The effect of surgeon’s pose and duration of operation on movement accuracy and level of microsurgical hand tremor","authors":"A. Bykanov, D. Pitskhelauri, M. A. Kirushin, O.A. Rastvorova, T. R. Zagidullin","doi":"10.17650/1683-3295-2024-26-1-76-82","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-76-82","url":null,"abstract":"Background. Physiological hand tremor is one of significant problems in microsurgical technique. One careless movement can cause damage to the neighboring structures and consequently worsen a patient’s condition. Therefore, the problem of reducing hand tremor remains relevant.Aim. To determine the effect of microsurgeon’s pose, duration of operation on the accuracy of surgical action and level of microsurgical hand tremor.Materials and methods. The study included 14 neurosurgery residents satisfying inclusion criteria. For evaluation and simulation of microsurgical action, validated and developed by the study authors devices for testing and surgical microscope Carl Zeiss were used. The experimental results were compared using univariate analysis. The differences were considered statistically significant at p <0.05.Results. Surgeon’s pose standing / sitting did not affect spatial accuracy of surgical action and the level of microsurgical hand tremor. However, statistically significant changes in hand tremor were observed both in standing and sitting positions with increased time of microsurgical action.Conclusion. The choice between sitting or standing pose for microsurgical operation is not a factor significantly affecting microsurgeon’s spatial accuracy of movement and hand tremor. Duration of surgical intervention affects the level of microsurgical hand tremor.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741103","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 : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-65-75
A. Khripun, A. D. Pryamikov, S. Asratyan, M. A. Belkov, A. B. Mironkov, V. S. Suryakhin, P. S. Esipov, A. L. Krasnikov, A. A. Churkin
Background. Traumatic brain injury (TBI) remains a big problem of modern neurosurgery, accompanied by high rates of disability and lethality. Venous thromboembolism (VTE) including venous thrombosis and pulmonary embolism (PE) plays a significant role in the structure of mortality in this pathology. Regimens and schemes of pharmacological prevention of VTE in TBI as well as corresponding preventative measures are not yet determined completely.Aim. To identify the frequency of VTE in patients with isolated moderate and severe TBI, and to evaluate the results of prevention and treatment of these complications in patients of this category.Materials and methods. Over a 3‑year period (from 2020 to 2023) 73 patients with isolated moderate and severe TBI (51 men and 22 women, mean age 61.0 ± 13.0 years) were treated in the V. M. Buyanov City Clinical Hospital. Of these, 31 patients received only conservative therapy, and 42 patients underwent surgery (craniotomy with hematoma removal, closed external hematoma drainage, and installation of intracranial pressure sensor). Ultrasound examination of the lower limb veins was performed at patient admission, then every 7 days until discharge from the hospital. Pharmacological prevention of VTE using low molecular weight heparin in non‑surgical patients was started after 1–2 days if computed tomography of the brain 24 h after admission showed no negative hematoma dynamics. Surgical patients were prescribed preventive medications 24 h after surgery if computed tomography confirmed intracranial hemostasis.Results. Venous thrombosis was detected in 22 (30.1 %) of 73 patients. PE complicated the underlying disease in 1 (1.4 %) case and was non‑fatal. There was no fatal PE in the study group. An increase of the initial intracranial hematoma volume occurred in 3 (4.1 %) patients, in 2 (2.8 %) patients the recurrence of hemorrhage occurred before the beginning of heparin administration, and in 1 (1.4 %) case against the background of therapeutic doses of anticoagulants prescribed for venous thrombosis. In the majority of cases (82.0 %; 18 of 22 patients) thromboses were localized in deep veins of the lower leg and were asymptomatic. Intrahospital mortality was 23.3 % (17 patients), all lethal outcomes were due to the course of traumatic brain disease.Conclusion. VTE is a frequent complication of TBI with intracranial hemorrhage. Regular ultrasound diagnostics makes it possible to diagnose asymptomatic distal venous thrombosis in a timely manner and to prescribe therapeutic doses of low molecular weight heparin in time which in turn allows to avoid fatal PE. Currently, there are no clear domestic recommendations for the prevention and, most importantly, for the treatment of these complications in patients with isolated moderate and severe TBI, which requires further active study of this problem.
{"title":"Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury","authors":"A. Khripun, A. D. Pryamikov, S. Asratyan, M. A. Belkov, A. B. Mironkov, V. S. Suryakhin, P. S. Esipov, A. L. Krasnikov, A. A. Churkin","doi":"10.17650/1683-3295-2024-26-1-65-75","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-65-75","url":null,"abstract":"Background. Traumatic brain injury (TBI) remains a big problem of modern neurosurgery, accompanied by high rates of disability and lethality. Venous thromboembolism (VTE) including venous thrombosis and pulmonary embolism (PE) plays a significant role in the structure of mortality in this pathology. Regimens and schemes of pharmacological prevention of VTE in TBI as well as corresponding preventative measures are not yet determined completely.Aim. To identify the frequency of VTE in patients with isolated moderate and severe TBI, and to evaluate the results of prevention and treatment of these complications in patients of this category.Materials and methods. Over a 3‑year period (from 2020 to 2023) 73 patients with isolated moderate and severe TBI (51 men and 22 women, mean age 61.0 ± 13.0 years) were treated in the V. M. Buyanov City Clinical Hospital. Of these, 31 patients received only conservative therapy, and 42 patients underwent surgery (craniotomy with hematoma removal, closed external hematoma drainage, and installation of intracranial pressure sensor). Ultrasound examination of the lower limb veins was performed at patient admission, then every 7 days until discharge from the hospital. Pharmacological prevention of VTE using low molecular weight heparin in non‑surgical patients was started after 1–2 days if computed tomography of the brain 24 h after admission showed no negative hematoma dynamics. Surgical patients were prescribed preventive medications 24 h after surgery if computed tomography confirmed intracranial hemostasis.Results. Venous thrombosis was detected in 22 (30.1 %) of 73 patients. PE complicated the underlying disease in 1 (1.4 %) case and was non‑fatal. There was no fatal PE in the study group. An increase of the initial intracranial hematoma volume occurred in 3 (4.1 %) patients, in 2 (2.8 %) patients the recurrence of hemorrhage occurred before the beginning of heparin administration, and in 1 (1.4 %) case against the background of therapeutic doses of anticoagulants prescribed for venous thrombosis. In the majority of cases (82.0 %; 18 of 22 patients) thromboses were localized in deep veins of the lower leg and were asymptomatic. Intrahospital mortality was 23.3 % (17 patients), all lethal outcomes were due to the course of traumatic brain disease.Conclusion. VTE is a frequent complication of TBI with intracranial hemorrhage. Regular ultrasound diagnostics makes it possible to diagnose asymptomatic distal venous thrombosis in a timely manner and to prescribe therapeutic doses of low molecular weight heparin in time which in turn allows to avoid fatal PE. Currently, there are no clear domestic recommendations for the prevention and, most importantly, for the treatment of these complications in patients with isolated moderate and severe TBI, which requires further active study of this problem.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741621","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 : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-83-91
V. S. Dementievskiy, E. A. Lekhnov, S. S. Baldina, G. N. Litvinchuk, D. Rzaev
Intermediate nerve neuralgia (INN) is a rare pathology with difficult diagnostics and currently there is no generally accepted surgical management protocol. In this regard, an optimal surgical strategy in this case is a difficult task. The aim was to determine an optimal approach for surgical management of patients with INN using intraoperative neurophysiological monitoring (IONM).The INN was diagnosed in a patient, a vestibulo‑cochlear complex dissection with intermediate nerve sectioning under IONM control of was performed intraoperatively. There was the earache regression, but there were gustatory disorders in the anterior portion on the left side of the tongue in the early postoperative period. In the late postoperative period, a delayed facial nerve paresis and signs of liquorrhea were diagnosed, which were completely regressed after reoperation and medication. The follow‑up period was more than 12 months; a stable regression of otoalgia was achieved. Intermediate nerve sectioning is an effective and common technique for the treatment of patients with INN. IONM improves surgical results and reduces a likelihood of different complications.
中间神经痛（INN）是一种罕见的病症，诊断困难，目前还没有公认的手术治疗方案。因此，为这种病例制定最佳手术策略是一项艰巨的任务。我们的目的是利用术中神经电生理监测（IONM）确定 INN 患者手术治疗的最佳方法。一名患者被确诊为 INN，术中在 IONM 控制下进行了前庭-耳蜗复合体解剖和中间神经切断术。术后早期，耳痛消失，但左侧舌前区出现味觉障碍。术后晚期，患者出现迟发性面神经麻痹和腹泻症状，经过再次手术和药物治疗后，症状完全缓解。随访时间超过 12 个月，口痛稳定缓解。中间神经切断术是治疗 INN 患者的一种有效而常见的技术。中间神经切断术可改善手术效果，降低出现各种并发症的可能性。
{"title":"Surgical treatment of intermediate nerve neuralgia using intraoperative neurophysiological monitoring","authors":"V. S. Dementievskiy, E. A. Lekhnov, S. S. Baldina, G. N. Litvinchuk, D. Rzaev","doi":"10.17650/1683-3295-2024-26-1-83-91","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-83-91","url":null,"abstract":"Intermediate nerve neuralgia (INN) is a rare pathology with difficult diagnostics and currently there is no generally accepted surgical management protocol. In this regard, an optimal surgical strategy in this case is a difficult task. The aim was to determine an optimal approach for surgical management of patients with INN using intraoperative neurophysiological monitoring (IONM).The INN was diagnosed in a patient, a vestibulo‑cochlear complex dissection with intermediate nerve sectioning under IONM control of was performed intraoperatively. There was the earache regression, but there were gustatory disorders in the anterior portion on the left side of the tongue in the early postoperative period. In the late postoperative period, a delayed facial nerve paresis and signs of liquorrhea were diagnosed, which were completely regressed after reoperation and medication. The follow‑up period was more than 12 months; a stable regression of otoalgia was achieved. Intermediate nerve sectioning is an effective and common technique for the treatment of patients with INN. IONM improves surgical results and reduces a likelihood of different complications.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"15 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743295","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 : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-25-33
A. N. Shkarubo, I. V. Chernov, A. A. Veselkov, M. A. Kutin, D. V. Fomichev, O. I. Sharipov, D. N. Andreev, D. S. Kim, A. Donskoy, I. S. Klochkova, M. Sinelnikov, P. Kalinin
Background. Cavernoma of cavernous sinus is a fairly rare benign neoplasm, accounting for less than 3 % of all neoplasms in this area. Due to the rarity of this pathology, a standardized protocol for diagnosis or treatment has not been developed. Surgical and radiosurgical methods are used for treatment.Aim. Analysis of the results of treatment of patients with cavernous sinus cavernomas operated at the N. N. Burdenko National Medical Research Center of Neurosurgery from 2000 to 2022 using endoscopic transnasal access.Materials and methods. We present our own experience in the treatment of 9 patients who underwent transnasal endoscopic removal of cavernous sinus cavernoma.Results. A total of about 300 cases of treatment of patients with cavernous sinus cavernomas have been described in the literature, and endoscopic removal has been described in only 12 cases.As a result, subtotal removal was achieved in 7 cases. In 2 cases, the removal was partial. The postoperative period proceeded in all patients without peculiarities and without complications.Conclusion. Endoscopic transnasal access allows partial or subtotal removal of the formation without risk of injury to cranial nerves and with minimal soft tissue injury, which has a positive effect on the postoperative period of patients. In combination with radiosurgical methods, it is possible to achieve satisfactory treatment results.
背景：海绵窦海绵瘤是一种相当罕见的良性肿瘤。海绵窦海绵瘤是一种相当罕见的良性肿瘤，占该部位所有肿瘤的比例不到 3%。由于这种病变的罕见性，目前尚未制定出标准的诊断或治疗方案。目前主要采用手术和放射外科方法进行治疗。分析 2000 年至 2022 年期间在 N. N. Burdenko 国立神经外科医学研究中心使用内窥镜经鼻入路手术治疗海绵窦海绵瘤患者的结果。我们介绍了自己治疗 9 例经鼻内镜切除海绵窦海绵瘤患者的经验。文献中总共描述了约 300 例海绵窦海绵瘤患者的治疗，其中仅有 12 例描述了内窥镜切除术。结果，7 例实现了次全部切除，2 例实现了部分切除。所有患者术后均无特殊情况和并发症。结论：内窥镜经鼻入路可以部分或次全部切除形成的肿瘤，不会有损伤颅神经的风险，对软组织的损伤也很小，这对患者的术后恢复有积极影响。结合放射外科手术方法，可以取得令人满意的治疗效果。
{"title":"Cavernomas of cavernous sinus","authors":"A. N. Shkarubo, I. V. Chernov, A. A. Veselkov, M. A. Kutin, D. V. Fomichev, O. I. Sharipov, D. N. Andreev, D. S. Kim, A. Donskoy, I. S. Klochkova, M. Sinelnikov, P. Kalinin","doi":"10.17650/1683-3295-2024-26-1-25-33","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-25-33","url":null,"abstract":"Background. Cavernoma of cavernous sinus is a fairly rare benign neoplasm, accounting for less than 3 % of all neoplasms in this area. Due to the rarity of this pathology, a standardized protocol for diagnosis or treatment has not been developed. Surgical and radiosurgical methods are used for treatment.Aim. Analysis of the results of treatment of patients with cavernous sinus cavernomas operated at the N. N. Burdenko National Medical Research Center of Neurosurgery from 2000 to 2022 using endoscopic transnasal access.Materials and methods. We present our own experience in the treatment of 9 patients who underwent transnasal endoscopic removal of cavernous sinus cavernoma.Results. A total of about 300 cases of treatment of patients with cavernous sinus cavernomas have been described in the literature, and endoscopic removal has been described in only 12 cases.As a result, subtotal removal was achieved in 7 cases. In 2 cases, the removal was partial. The postoperative period proceeded in all patients without peculiarities and without complications.Conclusion. Endoscopic transnasal access allows partial or subtotal removal of the formation without risk of injury to cranial nerves and with minimal soft tissue injury, which has a positive effect on the postoperative period of patients. In combination with radiosurgical methods, it is possible to achieve satisfactory treatment results.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"28 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743777","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 : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-34-40
V. Bobinov, S. Goroshchenko, E. Kolomin, L. Rozhchenko, K. Samochernykh, A. Petrov
Aim. To estimate the nearest and distant angiographic results of endovascular occlusion of aneurysms of the internal carotid artery ophthalmic segment using non‑reconstructive treatment methods.Materials and methods. The results of endovascular treatment of 75 patients with aneurysms of the ophthalmic segment of the internal carotid artery admitted to the Neurosurgical Department No. 3 of the V. L. Polenov Russian Research Neurosurgical Institute, from January 1, 2013 to December 31, 2016 were analyzed.Results. Of 75 aneurysms, 52 (69.3 %) were radically occluded from the blood flow (Type A) and 23 (30.7 %) were sub‑totally (Type B). When isolated occlusion with detachable coils was used, radical result was achieved in 13 (59.1 %) out of 22 cases, subtotal occlusion – in 9 (40.9 %). During balloon‑assisted occlusion 39 (73.6 %) out of 53 aneurysms were shut off from the blood flow totally, 14 (26.4 %) – sub‑totally. Partial aneurysm occlusion (Type C) was not achieved in any of the observations. Recurrence was observed in 3 (30 %) out of 10 cases on control angiography after isolated occlusion with detached spirals, and 2 (20 %) required repeated surgical intervention. From 38 aneurysms operated on using balloon‑assistence, 9 (23,7 %) recurred on control angiography, 6 of them (15,8 %) required repeated surgical intervention.Conclusion. Nonconstructive surgical interventions for occlusion of aneurysms of the internal carotid artery ophthalmic segment are still urgent and effective method of treatment of patients in acute period of aneurysm rupture combined with somatic status; however, they are inferior to reconstructive surgeries concerning radica lity in the long‑term period.
{"title":"Ophthalmic segment internal carotid artery aneurysms endovascular treatment","authors":"V. Bobinov, S. Goroshchenko, E. Kolomin, L. Rozhchenko, K. Samochernykh, A. Petrov","doi":"10.17650/1683-3295-2024-26-1-34-40","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-34-40","url":null,"abstract":"Aim. To estimate the nearest and distant angiographic results of endovascular occlusion of aneurysms of the internal carotid artery ophthalmic segment using non‑reconstructive treatment methods.Materials and methods. The results of endovascular treatment of 75 patients with aneurysms of the ophthalmic segment of the internal carotid artery admitted to the Neurosurgical Department No. 3 of the V. L. Polenov Russian Research Neurosurgical Institute, from January 1, 2013 to December 31, 2016 were analyzed.Results. Of 75 aneurysms, 52 (69.3 %) were radically occluded from the blood flow (Type A) and 23 (30.7 %) were sub‑totally (Type B). When isolated occlusion with detachable coils was used, radical result was achieved in 13 (59.1 %) out of 22 cases, subtotal occlusion – in 9 (40.9 %). During balloon‑assisted occlusion 39 (73.6 %) out of 53 aneurysms were shut off from the blood flow totally, 14 (26.4 %) – sub‑totally. Partial aneurysm occlusion (Type C) was not achieved in any of the observations. Recurrence was observed in 3 (30 %) out of 10 cases on control angiography after isolated occlusion with detached spirals, and 2 (20 %) required repeated surgical intervention. From 38 aneurysms operated on using balloon‑assistence, 9 (23,7 %) recurred on control angiography, 6 of them (15,8 %) required repeated surgical intervention.Conclusion. Nonconstructive surgical interventions for occlusion of aneurysms of the internal carotid artery ophthalmic segment are still urgent and effective method of treatment of patients in acute period of aneurysm rupture combined with somatic status; however, they are inferior to reconstructive surgeries concerning radica lity in the long‑term period.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"23 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744138","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 : 2024-04-04DOI: 10.17650/1683-3295-2024-26-1-54-64
A. Kholyavin, A. V. Peskov, A. O. Berger
Background. Stereotactic operations on the ventral‑intermediate nucleus of the thalamus (Vim) and the posterior subthalamic area (PSA) are used for the surgical treatment of tremor. Since these structures are invisible in standard magnetic resonance imaging (MRI) regimes, indirect stereotactic guidance is mainly used during operations. MRI tractography allows taking into account the individual variability of the target structures for tremor, visualizing the target directly, but this technique has not yet entered the routine practice of preparing operations.Aim. The aim of the work is to study the variability of the position of the dentato‑rubro‑thalamic tract (DRT), determined according to MRI tractography data, in relation to the main reference points for indirect stereotactic guidance, as well as to the visible landmarks on MRI in FGATIR mode, to assess the validity of the currently used methods of preparing operations in patients with tremor.Materials and methods. Probabilistic MRI tractography of DRT based on the HARDY protocol was performed in 34 patients. Additionally, 3D T1 tomograms were obtained with axial slices with an isotropic voxel size equal to 1 mm, as well as FLAIR sagittal slices with a thickness of 1.12 and a pitch of 0.56 mm. Eleven patients additionally underwent a series of MRI sections according to the FGATIR program with a thickness of 1 mm, without an intersectional gap.Results. A significant variability of the DRT position has been established both in the coordinate system of the anterior and posterior commissures, and in relation to standard targets for indirect stereotactic guidance. In addition, a visible interhemispheric asymmetry of the position of the tracts was revealed. The smallest degree of deviation from the tract was noted for the trajectories of deep brain stimulation electrodes implanted in the caudal zona incerta (cZI) at the level of the maximum diameter of the red nuclei. A high degree of correspondence between the tract and the target zone of prelemniscal radiations (Raprl) was also established on tomograms in the FGATIR mode.Conclusions. The standard target points for the indirect targeting of Vim targets and the cerebello‑thalamic tract in PSA give a deviation of more than 2 mm from DRT in almost half of patients. During the use of cZI as a standard target for indirect guidance in the treatment of tremor, the DRT is located at the zone of stereotactic impact at the level of the 2nd or 3rd contact of the electrode in 76.5 % of cases. FGATIR mode allows visualizing the structure of Raprl, with stereotactic guidance on which the effect on the DRT can be achieved in 86.4 % of cases.
{"title":"The individual variability of the dentato-rubro-thalamic tract in the planning of stereotactic operations in patients with tremor","authors":"A. Kholyavin, A. V. Peskov, A. O. Berger","doi":"10.17650/1683-3295-2024-26-1-54-64","DOIUrl":"https://doi.org/10.17650/1683-3295-2024-26-1-54-64","url":null,"abstract":"Background. Stereotactic operations on the ventral‑intermediate nucleus of the thalamus (Vim) and the posterior subthalamic area (PSA) are used for the surgical treatment of tremor. Since these structures are invisible in standard magnetic resonance imaging (MRI) regimes, indirect stereotactic guidance is mainly used during operations. MRI tractography allows taking into account the individual variability of the target structures for tremor, visualizing the target directly, but this technique has not yet entered the routine practice of preparing operations.Aim. The aim of the work is to study the variability of the position of the dentato‑rubro‑thalamic tract (DRT), determined according to MRI tractography data, in relation to the main reference points for indirect stereotactic guidance, as well as to the visible landmarks on MRI in FGATIR mode, to assess the validity of the currently used methods of preparing operations in patients with tremor.Materials and methods. Probabilistic MRI tractography of DRT based on the HARDY protocol was performed in 34 patients. Additionally, 3D T1 tomograms were obtained with axial slices with an isotropic voxel size equal to 1 mm, as well as FLAIR sagittal slices with a thickness of 1.12 and a pitch of 0.56 mm. Eleven patients additionally underwent a series of MRI sections according to the FGATIR program with a thickness of 1 mm, without an intersectional gap.Results. A significant variability of the DRT position has been established both in the coordinate system of the anterior and posterior commissures, and in relation to standard targets for indirect stereotactic guidance. In addition, a visible interhemispheric asymmetry of the position of the tracts was revealed. The smallest degree of deviation from the tract was noted for the trajectories of deep brain stimulation electrodes implanted in the caudal zona incerta (cZI) at the level of the maximum diameter of the red nuclei. A high degree of correspondence between the tract and the target zone of prelemniscal radiations (Raprl) was also established on tomograms in the FGATIR mode.Conclusions. The standard target points for the indirect targeting of Vim targets and the cerebello‑thalamic tract in PSA give a deviation of more than 2 mm from DRT in almost half of patients. During the use of cZI as a standard target for indirect guidance in the treatment of tremor, the DRT is located at the zone of stereotactic impact at the level of the 2nd or 3rd contact of the electrode in 76.5 % of cases. FGATIR mode allows visualizing the structure of Raprl, with stereotactic guidance on which the effect on the DRT can be achieved in 86.4 % of cases.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"62 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743147","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 : 2024-01-28DOI: 10.17650/1683-3295-2023-25-4-114-118
P. Shnyakin, D. Rzaev, P. G. Rudenko
Complications of operations are negative, but inevitable companions of surgery and determine dissatisfaction with the outcome of treatment for both the doctor and the patient. In this regard, the improvement of the results of surgical treatment is associated not only with the improvement of the technique and skill of the surgeon, but also with the prevention and control of complications. On this path, it is necessary to analyze complications from your own practice and share negative experiences in scientific publications, at conferences, in the educational process. Despite the significance of the problem, there is still no single approved definition of “complication of surgery” in the surgical literature, and experts’ opinions on this matter differ. It is quite difficult to analyze scientific publications on this topic when different indicators of the frequency and structure of complications can be determined by different understanding of the term “complication” by specialists. This review presents the main approaches to the definition of “complication of surgery”, as well as other definitions proposed by some authors (“consequence of surgery”, “undesirable perioperative events”). Based on the conducted review, a variant of the use of terms is proposed.
{"title":"Complications of operations in neurosurgery","authors":"P. Shnyakin, D. Rzaev, P. G. Rudenko","doi":"10.17650/1683-3295-2023-25-4-114-118","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-114-118","url":null,"abstract":"Complications of operations are negative, but inevitable companions of surgery and determine dissatisfaction with the outcome of treatment for both the doctor and the patient. In this regard, the improvement of the results of surgical treatment is associated not only with the improvement of the technique and skill of the surgeon, but also with the prevention and control of complications. On this path, it is necessary to analyze complications from your own practice and share negative experiences in scientific publications, at conferences, in the educational process. Despite the significance of the problem, there is still no single approved definition of “complication of surgery” in the surgical literature, and experts’ opinions on this matter differ. It is quite difficult to analyze scientific publications on this topic when different indicators of the frequency and structure of complications can be determined by different understanding of the term “complication” by specialists. This review presents the main approaches to the definition of “complication of surgery”, as well as other definitions proposed by some authors (“consequence of surgery”, “undesirable perioperative events”). Based on the conducted review, a variant of the use of terms is proposed.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491172","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 : 2024-01-28DOI: 10.17650/1683-3295-2023-25-4-104-113
V. Smirnov, A. E. Talypov, Ya. V. Morozova, S. M. Radaev, S. I. Ryabov, M. Zvyagintseva, S. Bazanovich, A. Grin
Trauma of the spinal cord is a severe injury of the structure of the central nervous system leading to deep and enduring disability in most patients. Treatment and rehabilitation of such patients are associated with high costs to the state. Disability imposes even greater financial burden: loss of ability to work, expenses for financial assistance, yearly reha‑ bilitation, etc. Currently, methods of regenerative medicine are being actively developed and they are promising from the clinical point of view. However, effective treatment of spinal cord injury and recovery of even partial ability to work in patients should also have positive results from the financial standpoint. In 2018, we have completed the first part of a clinical trial confirming safety and high effectiveness of systemic use of umbilical-placental blood in the acute period of spinal cord injury. Based on the trial results, we have calculated potential financial benefit for the state from development of new methods of regenerative therapy for treatment of spinal cord injuries. In this article, we present financial and economic rationale for using such trials in current conditions.
{"title":"Financial and economic rationale for using emerging cell therapy technologies for treatment of traumatic injuries of the central nervous system in high technology healthcare","authors":"V. Smirnov, A. E. Talypov, Ya. V. Morozova, S. M. Radaev, S. I. Ryabov, M. Zvyagintseva, S. Bazanovich, A. Grin","doi":"10.17650/1683-3295-2023-25-4-104-113","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-104-113","url":null,"abstract":"Trauma of the spinal cord is a severe injury of the structure of the central nervous system leading to deep and enduring disability in most patients. Treatment and rehabilitation of such patients are associated with high costs to the state. Disability imposes even greater financial burden: loss of ability to work, expenses for financial assistance, yearly reha‑ bilitation, etc. Currently, methods of regenerative medicine are being actively developed and they are promising from the clinical point of view. However, effective treatment of spinal cord injury and recovery of even partial ability to work in patients should also have positive results from the financial standpoint. In 2018, we have completed the first part of a clinical trial confirming safety and high effectiveness of systemic use of umbilical-placental blood in the acute period of spinal cord injury. Based on the trial results, we have calculated potential financial benefit for the state from development of new methods of regenerative therapy for treatment of spinal cord injuries. In this article, we present financial and economic rationale for using such trials in current conditions.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"140 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491892","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 : 2024-01-28DOI: 10.17650/1683-3295-2023-25-4-129-137
A. Dmitriev, M. Sinkin, A. A. Solodov, V. Dashyan
To reduce patient’s discomfort during awake surgery convenient patient’s position on operation table is applied, comfort temperature and close contact to psychologist are supported. Anesthesiologic features of awake surgery include regional and conduction anesthesia of scalp nerves, light sedation, attentive control over air ways and dural infiltration with anesthetics. Keeping patient’s consciousness during surgical approach increases reliability of intraoperative tests but demands more thorough anesthesia and control over patient’s condition.Neuromonitoring in awake patient increases extent of gliomas’ resection and decreases risk of permanent neurological disorders.Risks of awake surgery are devided into respiratory, neurological, cardiological and psychological. Intraoperative seizures arise in 3–12 % of cases.Most of the patients rate awake surgery positively and agree to repeated similar operations.
{"title":"Awake surgery in neurooncology. Part 1. Anesthesia features, selection of patients, method’s advantages and drawbacks","authors":"A. Dmitriev, M. Sinkin, A. A. Solodov, V. Dashyan","doi":"10.17650/1683-3295-2023-25-4-129-137","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-129-137","url":null,"abstract":"To reduce patient’s discomfort during awake surgery convenient patient’s position on operation table is applied, comfort temperature and close contact to psychologist are supported. Anesthesiologic features of awake surgery include regional and conduction anesthesia of scalp nerves, light sedation, attentive control over air ways and dural infiltration with anesthetics. Keeping patient’s consciousness during surgical approach increases reliability of intraoperative tests but demands more thorough anesthesia and control over patient’s condition.Neuromonitoring in awake patient increases extent of gliomas’ resection and decreases risk of permanent neurological disorders.Risks of awake surgery are devided into respiratory, neurological, cardiological and psychological. Intraoperative seizures arise in 3–12 % of cases.Most of the patients rate awake surgery positively and agree to repeated similar operations.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"193 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491567","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 : 2024-01-28DOI: 10.17650/1683-3295-2023-25-4-138-147
S. Gizatullin, M. B. Ovchinnikova, I. Isengaliev, I. A. Klimov, E. G. Kolobaeva
In 2022, 315 years have passed since the founding of N.N. Burdenko Main Military Clinical Hospital and 70 years of the formation of the Neurosurgical Department of the Hospital. The history of the hospital allows us to talk about the provision of neurosurgical care from the day of its foundation, which is confirmed by numerous documents and facts. The article presents the historical milestones in the development of neurosurgical care in the hospital for more than 300 years – from the Petrine era to the present. The main trends in the development of neurosurgical care at the present stage are outlined.
{"title":"Pages of the history of national neurosurgery. To the 70th anniversary of the Burdenko hospital neurosurgical clinic","authors":"S. Gizatullin, M. B. Ovchinnikova, I. Isengaliev, I. A. Klimov, E. G. Kolobaeva","doi":"10.17650/1683-3295-2023-25-4-138-147","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-138-147","url":null,"abstract":"In 2022, 315 years have passed since the founding of N.N. Burdenko Main Military Clinical Hospital and 70 years of the formation of the Neurosurgical Department of the Hospital. The history of the hospital allows us to talk about the provision of neurosurgical care from the day of its foundation, which is confirmed by numerous documents and facts. The article presents the historical milestones in the development of neurosurgical care in the hospital for more than 300 years – from the Petrine era to the present. The main trends in the development of neurosurgical care at the present stage are outlined.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"145 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491408","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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