Pub Date : 2024-01-28DOI: 10.17650/1683-3295-2023-25-4-119-128
T. G. Kairov, A. E. Talypov, A. Grin
The article discusses the epidemiology, types and features of the pathogenesis of early complications of decompressive craniectomy in patients with severe traumatic brain injury.
文章讨论了严重脑外伤患者颅骨减压切除术早期并发症的流行病学、类型和发病机制特点。
{"title":"Early complications of decompressive craniectomy in patients with severe traumatic brain injury","authors":"T. G. Kairov, A. E. Talypov, A. Grin","doi":"10.17650/1683-3295-2023-25-4-119-128","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-119-128","url":null,"abstract":"The article discusses the epidemiology, types and features of the pathogenesis of early complications of decompressive craniectomy in patients with severe traumatic brain injury.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"172 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491368","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 : 2024-01-27DOI: 10.17650/1683-3295-2023-25-4-96-103
V. V. Krylov, V. A. Lukianchikov, V. A. Gorozhanin, Z. Barbakadze, M. Sinkin
Aim. To present a technique for continuous monitoring of corticospinal tract integrity using an electrode with a dynamic balloon, examine the advantages and disadvantages of the selected and alternative monitoring techniques.Materials and methods. At the 1st stage, an electrode combined with a dynamic balloon was prepared. At the 2nd stage, continuous monitoring of the corticospinal tract using direct stimulation of the cortex using ballon grid during the main stage of cerebral surgery was performed. At the 3rd stage, interpretation of the obtained neurophysiological responses was performed.Results. The presented technique of continuous monitoring of the integrity of the corticospinal tract through direct cortical stimulation using the developed device prevents false response decreases which significantly helps with the interpretation of the obtained results and increases information value of the technique. The described technique is based on the presented clinical observations of intracerebral tumor resection, as well as microsurgical aneurysm clipping using the technique. During surgery, no false decrease of the neurophysiological signal amplitude was observed due to dynamic ballon inflation and maintenance of close contact between the electrode and the surface of the brain. A surgery performed using this technique allowed to achieve a favorable neurological outcome in a patient in the postoperative period.Conclusion. The presented device allows to perform continuous neuromonitoring using direct cortical electrostimulation with a strip electrode at any level of brain retraction. The technique decreases the risk of primary and secondary injury of the corticospinal and corticobulbar tracts which increases safety of neurosurgical intervention and decreases risks of neurological complications.
{"title":"Technique for intraoperative monitoring of corticospinal tract integrity using an electrode with a dynamic balloon","authors":"V. V. Krylov, V. A. Lukianchikov, V. A. Gorozhanin, Z. Barbakadze, M. Sinkin","doi":"10.17650/1683-3295-2023-25-4-96-103","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-96-103","url":null,"abstract":"Aim. To present a technique for continuous monitoring of corticospinal tract integrity using an electrode with a dynamic balloon, examine the advantages and disadvantages of the selected and alternative monitoring techniques.Materials and methods. At the 1st stage, an electrode combined with a dynamic balloon was prepared. At the 2nd stage, continuous monitoring of the corticospinal tract using direct stimulation of the cortex using ballon grid during the main stage of cerebral surgery was performed. At the 3rd stage, interpretation of the obtained neurophysiological responses was performed.Results. The presented technique of continuous monitoring of the integrity of the corticospinal tract through direct cortical stimulation using the developed device prevents false response decreases which significantly helps with the interpretation of the obtained results and increases information value of the technique. The described technique is based on the presented clinical observations of intracerebral tumor resection, as well as microsurgical aneurysm clipping using the technique. During surgery, no false decrease of the neurophysiological signal amplitude was observed due to dynamic ballon inflation and maintenance of close contact between the electrode and the surface of the brain. A surgery performed using this technique allowed to achieve a favorable neurological outcome in a patient in the postoperative period.Conclusion. The presented device allows to perform continuous neuromonitoring using direct cortical electrostimulation with a strip electrode at any level of brain retraction. The technique decreases the risk of primary and secondary injury of the corticospinal and corticobulbar tracts which increases safety of neurosurgical intervention and decreases risks of neurological complications.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140493091","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 : 2024-01-27DOI: 10.17650/1683-3295-2023-25-4-68-78
M. M. Sehweil Salah, Z. Goncharova
Background. A vast ischemic lesion in cases of malignant middle cerebral artery infarction causes a massive edema of the affected cerebral hemisphere, which leads to development of the dislocation syndrome and, in most cases, death. Decompressive hemicraniectomy is a more effective method for treatment of malignant ischemic infarction, than conservative therapy.Aim. Evaluation of the effectiveness of treatment of malignant middle cerebral artery infarction.Materials and methods. Analysis was carried out of the case histories of 57 patients with malignant middle cerebral artery infarction, out of which number 64.9 % were women and 35.1 % were men. The patients’ ages varied from 49 to 90 years, with the average of 72.7 year. All patients were divided into two groups: Group 1 patients (n = 47, 82.5 %) received only conservative therapy, while Group 2 patients (n = 10, 17.5 %) were subjected to surgical treatment.Results. The in-hospital stay of Group 1 patients varied from 2 to 73 days (the mean stay being 14.4 ± 1.8 days). Lethality in the conservative therapy patients was 46.8 % during the in-hospital stay varying from 2 to 21 days, with the average of 7.7 ± 1.7 days. Based on the postmortem examination, dislocation syndrome and its consequences were the cause of death in 90.9 % of the patients, who received in-hospital conservative therapy.The in-hospital stay of Group 2 patients varied from 22 to 33 days, with the average of 19.6 ± 4.3 days. The postoperative mortality was 40 %. The postmortem examination showed that the cause of the deaths was exacerbation of the dislocation syndrome and its consequences.Conclusion. Malignant ischemic syndrome in the territory supplied by the middle cerebral artery is the most severe form of ischemic infarction accompanied by constant disability of patients. Despite decompressive hemicraniectomy, lethality for the patients with malignant ischemic syndrome remains high, the principal cause being development of the dislocation syndrome.
{"title":"Assessment of the results of treatment of malignant middle cerebral artery infarction","authors":"M. M. Sehweil Salah, Z. Goncharova","doi":"10.17650/1683-3295-2023-25-4-68-78","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-68-78","url":null,"abstract":"Background. A vast ischemic lesion in cases of malignant middle cerebral artery infarction causes a massive edema of the affected cerebral hemisphere, which leads to development of the dislocation syndrome and, in most cases, death. Decompressive hemicraniectomy is a more effective method for treatment of malignant ischemic infarction, than conservative therapy.Aim. Evaluation of the effectiveness of treatment of malignant middle cerebral artery infarction.Materials and methods. Analysis was carried out of the case histories of 57 patients with malignant middle cerebral artery infarction, out of which number 64.9 % were women and 35.1 % were men. The patients’ ages varied from 49 to 90 years, with the average of 72.7 year. All patients were divided into two groups: Group 1 patients (n = 47, 82.5 %) received only conservative therapy, while Group 2 patients (n = 10, 17.5 %) were subjected to surgical treatment.Results. The in-hospital stay of Group 1 patients varied from 2 to 73 days (the mean stay being 14.4 ± 1.8 days). Lethality in the conservative therapy patients was 46.8 % during the in-hospital stay varying from 2 to 21 days, with the average of 7.7 ± 1.7 days. Based on the postmortem examination, dislocation syndrome and its consequences were the cause of death in 90.9 % of the patients, who received in-hospital conservative therapy.The in-hospital stay of Group 2 patients varied from 22 to 33 days, with the average of 19.6 ± 4.3 days. The postoperative mortality was 40 %. The postmortem examination showed that the cause of the deaths was exacerbation of the dislocation syndrome and its consequences.Conclusion. Malignant ischemic syndrome in the territory supplied by the middle cerebral artery is the most severe form of ischemic infarction accompanied by constant disability of patients. Despite decompressive hemicraniectomy, lethality for the patients with malignant ischemic syndrome remains high, the principal cause being development of the dislocation syndrome.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140492501","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 : 2024-01-27DOI: 10.17650/1683-3295-2023-25-4-87-95
A. A. Ayrapetyan, D. G. Gromov, S. Papoyan, D. V. Smyalovskiy, K. S. Asaturyan, S. S. Starikov, A. Zaytsev, E. V. Tavlueva
Traumatic vertebral artery injury (TVAI) is a rare but severe pathology which can be associated both with penetrating injury of the neck and blunt or unclassified injury. Injury of the vertebral artery, especially due to gunshot or knife wounds, causes severe condition of the patients, development of a wide spectrum of complications including life-threatening, high rates of disabilities and mortality.There is no consensus on the treatment tactics for this pathology. Open surgery as the first stage of surgical intervention can be used in a limited number of cases. X-ray endovascular techniques of TVAI treatment are considered to be preferable.We present a clinical case of a 27‑year-old patient with TVAI caused by a penetrating gunshot wound of the neck and complicated by formation of a giant pseudoaneurysm of the V3 segment of the vertebral artery. Two-stage combination treatment of TVAI was performed using endovascular and open surgical techniques.Descriptions of TVAI cases are rare, and further accumulation and analysis of corresponding data and proposals on treatment of the patients with TVAI will help to formulate precise algorithms of doctors’ actions and optimize treatment tactics.
{"title":"Traumatic injury of vertebral artery complicated by formation of a giant pseudoaneurysm of the V3 segment (clinical observation and literature review)","authors":"A. A. Ayrapetyan, D. G. Gromov, S. Papoyan, D. V. Smyalovskiy, K. S. Asaturyan, S. S. Starikov, A. Zaytsev, E. V. Tavlueva","doi":"10.17650/1683-3295-2023-25-4-87-95","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-87-95","url":null,"abstract":"Traumatic vertebral artery injury (TVAI) is a rare but severe pathology which can be associated both with penetrating injury of the neck and blunt or unclassified injury. Injury of the vertebral artery, especially due to gunshot or knife wounds, causes severe condition of the patients, development of a wide spectrum of complications including life-threatening, high rates of disabilities and mortality.There is no consensus on the treatment tactics for this pathology. Open surgery as the first stage of surgical intervention can be used in a limited number of cases. X-ray endovascular techniques of TVAI treatment are considered to be preferable.We present a clinical case of a 27‑year-old patient with TVAI caused by a penetrating gunshot wound of the neck and complicated by formation of a giant pseudoaneurysm of the V3 segment of the vertebral artery. Two-stage combination treatment of TVAI was performed using endovascular and open surgical techniques.Descriptions of TVAI cases are rare, and further accumulation and analysis of corresponding data and proposals on treatment of the patients with TVAI will help to formulate precise algorithms of doctors’ actions and optimize treatment tactics.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"82 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140492722","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 : 2024-01-27DOI: 10.17650/1683-3295-2023-25-4-79-86
I. V. Senko, E. S. Ryzhkova, O. I. Patsap, M. B. Dolgushin
The aim of the study is to present rare clinical cases of isolated cerebral varices, summarize scientific literature data on their diagnosis and treatment.The article describes 2 clinical observations of isolated cerebral varix, presents a literature review of this topic, as well as treatment tactics for patients with this pathology.In the first clinical observation, in a male 72‑year-old patient isolated cerebral varix was interpreted as distal saccular aneurysm of the right middle cerebral artery per computed angiography data. Surgical treatment was performed: from subtemporal approach in the area of the floor of the middle cranial fossa, cerebral varix, inflow and outflow veins were visualized. The inflow and outflow veins were clipped, aneurysm was resected and sent to histological examination. The patient was discharged on day 8 after surgery. Histological examination of the cerebral varix wall showed typical components for a venous wall, in particular, individual smooth muscle fibers, absence of elastic membrane.In the second clinical observation, in a female 59‑year-old patient magnetic resonance (MR) imaging, MR angiography and MR venography in the projection of anterior basal parts of the left temporal area showed an aneurysmal malformation transitioning into the superficial middle cerebral vein. Taking into consideration venous pathogenesis of the vascular lesion, dynamic observation of the patient was chosen.Isolated cerebral varix is a rare vascular pathology without a specific clinical and instrumental picture. To avoid erroneous diagnosis and determine further treatment tactics, additional examinations are recommended: MR imaging, MR angiography and MR venography.
{"title":"Isolated cerebral varices: clinical observations and literature review","authors":"I. V. Senko, E. S. Ryzhkova, O. I. Patsap, M. B. Dolgushin","doi":"10.17650/1683-3295-2023-25-4-79-86","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-79-86","url":null,"abstract":"The aim of the study is to present rare clinical cases of isolated cerebral varices, summarize scientific literature data on their diagnosis and treatment.The article describes 2 clinical observations of isolated cerebral varix, presents a literature review of this topic, as well as treatment tactics for patients with this pathology.In the first clinical observation, in a male 72‑year-old patient isolated cerebral varix was interpreted as distal saccular aneurysm of the right middle cerebral artery per computed angiography data. Surgical treatment was performed: from subtemporal approach in the area of the floor of the middle cranial fossa, cerebral varix, inflow and outflow veins were visualized. The inflow and outflow veins were clipped, aneurysm was resected and sent to histological examination. The patient was discharged on day 8 after surgery. Histological examination of the cerebral varix wall showed typical components for a venous wall, in particular, individual smooth muscle fibers, absence of elastic membrane.In the second clinical observation, in a female 59‑year-old patient magnetic resonance (MR) imaging, MR angiography and MR venography in the projection of anterior basal parts of the left temporal area showed an aneurysmal malformation transitioning into the superficial middle cerebral vein. Taking into consideration venous pathogenesis of the vascular lesion, dynamic observation of the patient was chosen.Isolated cerebral varix is a rare vascular pathology without a specific clinical and instrumental picture. To avoid erroneous diagnosis and determine further treatment tactics, additional examinations are recommended: MR imaging, MR angiography and MR venography.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"85 7-8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140491912","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 : 2024-01-27DOI: 10.17650/1683-3295-2023-25-4-57-67
K. Yashin, R. D. Zinatullin, I. S. Bratsev, D. V. Dubrovskiy, A. Ermolaev, M. Ostapyuk, M. A. Kutlaeva, M. Rasteryaeva, I. Medyanik, L. Kravets
Background. In patients with skull bone tumors, it was demonstrated that not only the oncological but also the cosmetic result has a significant influence on the long-term outcome. The traditional approach to the surgical treatment of tumor lesions of the skull bones is removal of the tumor and intraoperative modeling an artificial bone flap without a template. Recently, the technology of simultaneous resection and computer-aided design/computer-aided manufacturing (CAD/CAM) cranioplasty has received more and more attention.Aim. To compare the results of surgical treatment of patients with tumors of the cranial bones using the traditional approach (intraoperative formation of a plate to close the defect) and simultaneous resection followed by plastic surgery of the defect with a personalized implant made using preoperative virtual modeling.Materials and methods. The study included 24 patients with tumors of the skull or meningiomas with extracranial growth. Depending on the surgical procedure, patients were divided into 2 groups: group 1 (n = 13) – the technology of simultaneous resection and CAD/CAM cranioplasty; group 2 (n = 11) – where surgery was performed using a traditional approach based on intraoperative modeling an artificial bone flap without a template.Results. There were no statistically significant differences between groups in gender, age, time of surgery, blood loss, or time in hospital. The use of simultaneous resection and CAD/CAM cranioplasty did not demonstrate a statistically significant better result in terms of maintaining skull symmetry compared to the traditional approach. All patients had a good cosmetic result and there were no complications.Conclusion. The technology of simultaneous resection and CAD/CAM cranioplasty is an effective method of treating patients with neoplasmas of the skull bones. Despite the absence of statistically significant differences in the results of treatment of cranial bone tumors between this method and the traditional approach based on intraoperative modeling an artificial bone flap without a template this method seems to be a more precise providing the best cosmetic effect in patients with lesion in fronto-orbital region.
{"title":"Resection of tumors of the cranial bones with single-step defect reconstruction using a personalized implant","authors":"K. Yashin, R. D. Zinatullin, I. S. Bratsev, D. V. Dubrovskiy, A. Ermolaev, M. Ostapyuk, M. A. Kutlaeva, M. Rasteryaeva, I. Medyanik, L. Kravets","doi":"10.17650/1683-3295-2023-25-4-57-67","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-57-67","url":null,"abstract":"Background. In patients with skull bone tumors, it was demonstrated that not only the oncological but also the cosmetic result has a significant influence on the long-term outcome. The traditional approach to the surgical treatment of tumor lesions of the skull bones is removal of the tumor and intraoperative modeling an artificial bone flap without a template. Recently, the technology of simultaneous resection and computer-aided design/computer-aided manufacturing (CAD/CAM) cranioplasty has received more and more attention.Aim. To compare the results of surgical treatment of patients with tumors of the cranial bones using the traditional approach (intraoperative formation of a plate to close the defect) and simultaneous resection followed by plastic surgery of the defect with a personalized implant made using preoperative virtual modeling.Materials and methods. The study included 24 patients with tumors of the skull or meningiomas with extracranial growth. Depending on the surgical procedure, patients were divided into 2 groups: group 1 (n = 13) – the technology of simultaneous resection and CAD/CAM cranioplasty; group 2 (n = 11) – where surgery was performed using a traditional approach based on intraoperative modeling an artificial bone flap without a template.Results. There were no statistically significant differences between groups in gender, age, time of surgery, blood loss, or time in hospital. The use of simultaneous resection and CAD/CAM cranioplasty did not demonstrate a statistically significant better result in terms of maintaining skull symmetry compared to the traditional approach. All patients had a good cosmetic result and there were no complications.Conclusion. The technology of simultaneous resection and CAD/CAM cranioplasty is an effective method of treating patients with neoplasmas of the skull bones. Despite the absence of statistically significant differences in the results of treatment of cranial bone tumors between this method and the traditional approach based on intraoperative modeling an artificial bone flap without a template this method seems to be a more precise providing the best cosmetic effect in patients with lesion in fronto-orbital region.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140492036","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 : 2024-01-26DOI: 10.17650/1683-3295-2023-25-4-49-56
E. S. Druzhinina, D. Druzhinin, A. S. Karapetyan, N. N. Alipbekov, D. G. Nakonechny, Yu. V. Rogovskaya, N. N. Zavadenko
Background. The anterior interosseus nerve (AIN) syndrome is a rare pathology, with cause is discussed. The findings in isolated AIN patients are in the main trunk of median nerve. It is confirmed by neuroimaging data and intraoperative picture in the form of the construction of fascicles in the nerve.Aim. To describe the clinical and instrumental characteristics of patients with isolated non-traumatic lesion of AIN.Materials and methods. The clinical, electrophysiological and neuroimaging data of 7 patients with isolated nontraumatic lesion of AIN were retrospectively analyzed, three of whom underwent surgical treatment.Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8 points according to visual analog scale and a duration of 1.5 to 4 weeks. Weakness of the flexor pollicis longus from 1 to 3 points on the MRC (Medical Research Council Weakness) scale was observed in all cases, weakness of flexion of the distal phalanx of the index finger in 6 patients from 1 to 3 points, which indicated an isolated lesion of the anterior interosseous nerve.Needle electromyogram revealed denervation in c in all cases, 5 patients – in the pronator teres.The fascicular constriction from 1 or 2 sections of the median nerve were detected at the shoulder level on the affected side by ultrasound in 6 patients. An increase in the cross-sectional area of the median nerve at the shoulder level in 2 cases we observed, in one case the changes were o bilateral and asymmetric. In 2 cases, an increase in cross-sectional area of С5 root was noted on the affected side by no more than 23 % of the normal value. A change in echogenicity and size decrease of the pronator quadratus, when compared with the opposite side, was noted in all cases.Conclusion. Patients with isolated AIN syndrome needs intensive evaluation to identify the localization of the level of damage to the median nerve.
背景。骨间前神经（AIN）综合征是一种罕见的病理现象，本文对其病因进行了讨论。孤立的 AIN 患者的病变部位是正中神经的主干。神经影像学数据和术中显示的神经束状结构证实了这一点。描述孤立性非创伤性 AIN 病变患者的临床和器械特征。回顾性分析了 7 例孤立性非创伤性 AIN 病变患者的临床、电生理和神经影像学数据，其中 3 例患者接受了手术治疗。所有患者均主诉患侧上肢神经痛，根据视觉模拟量表，平均强度为8分，持续时间为1.5至4周。在所有病例中均发现屈指肌无力，MRC（医学研究委员会肌无力量表）显示为 1 至 3 分，6 名患者的食指远端指骨屈曲无力，显示为 1 至 3 分，这表明骨间前神经发生了孤立性病变。针刺肌电图显示，所有病例中都有 c 处神经支配，其中 5 名患者的前庭大肌有神经支配。超声波检查发现，6 名患者患侧肩部正中神经的 1 或 2 节筋膜收缩。有 2 例患者肩部正中神经的横截面积增大，其中 1 例为双侧不对称变化。在两个病例中，受影响一侧的 С5 根横截面积增加不超过正常值的 23%。与对侧相比，所有病例都发现发音肌的回声改变和大小减小。孤立性正中神经损伤综合征患者需要进行强化评估，以确定正中神经损伤的部位。
{"title":"Hourglass-like fascicular constriction of the median nerve: case series","authors":"E. S. Druzhinina, D. Druzhinin, A. S. Karapetyan, N. N. Alipbekov, D. G. Nakonechny, Yu. V. Rogovskaya, N. N. Zavadenko","doi":"10.17650/1683-3295-2023-25-4-49-56","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-49-56","url":null,"abstract":"Background. The anterior interosseus nerve (AIN) syndrome is a rare pathology, with cause is discussed. The findings in isolated AIN patients are in the main trunk of median nerve. It is confirmed by neuroimaging data and intraoperative picture in the form of the construction of fascicles in the nerve.Aim. To describe the clinical and instrumental characteristics of patients with isolated non-traumatic lesion of AIN.Materials and methods. The clinical, electrophysiological and neuroimaging data of 7 patients with isolated nontraumatic lesion of AIN were retrospectively analyzed, three of whom underwent surgical treatment.Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8 points according to visual analog scale and a duration of 1.5 to 4 weeks. Weakness of the flexor pollicis longus from 1 to 3 points on the MRC (Medical Research Council Weakness) scale was observed in all cases, weakness of flexion of the distal phalanx of the index finger in 6 patients from 1 to 3 points, which indicated an isolated lesion of the anterior interosseous nerve.Needle electromyogram revealed denervation in c in all cases, 5 patients – in the pronator teres.The fascicular constriction from 1 or 2 sections of the median nerve were detected at the shoulder level on the affected side by ultrasound in 6 patients. An increase in the cross-sectional area of the median nerve at the shoulder level in 2 cases we observed, in one case the changes were o bilateral and asymmetric. In 2 cases, an increase in cross-sectional area of С5 root was noted on the affected side by no more than 23 % of the normal value. A change in echogenicity and size decrease of the pronator quadratus, when compared with the opposite side, was noted in all cases.Conclusion. Patients with isolated AIN syndrome needs intensive evaluation to identify the localization of the level of damage to the median nerve.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140492965","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 : 2024-01-26DOI: 10.17650/1683-3295-2023-25-4-20-30
V. Smirnov, S. I. Ryabov, M. Zvyagintseva, S. Bazanovich, Ya. V. Morozova, S. M. Radaev, A. E. Talypov, A. Grin
Aim. To evaluate the efficiency of systemic (intravenous) application of cryopreserved human umbilical cord blood mononuclear cells (HUCBCs) in animal models of acute contusion spinal cord injury for the restoration of hind limb motor function and formation of posttraumatic cysts using clinically significant examination methods.Materials and methods. Adult female Sprague–Dowley rats were used for the study. Severe acute contusion spinal cord injury model was performed using standard “weight‑drop” method. All samples of cryopreserved HUCBCs concentrate were prestored prior to infusion for 3 to 4 years at –196 °C. Hind limbs motor function was evaluated using open‑field technique and standard BBB testing system. Magnetic resonance scanning was performed using high‑field magnetic resonance CleanScan 7.0 T tomography (Bruker BioSpin, Germany).Results. Intravenous infusions of HUCBCs were performed on Day 1 following acute severe spinal cord injury. Motor function assessment demonstrated significant (p <0.05) improvement of hind limbs motor function (up to 40–50 %) comparing to self‑healing outcomes. Moreover, by the Days 4 and 5 after severe spinal cord injury, the volume of posttraumatic cystic cavity decreases significantly (up to 40 %) (p <0.05).Conclusion. The obtained results demonstrated that cryopreserved HUCBCs can be used as an effective source for cell therapy of acute contusion spinal cord injury.
{"title":"Evaluation of human mononuclear umbilical cord blood cells systemic administration efficiency in the acute period of experimental severe spinal cord injury","authors":"V. Smirnov, S. I. Ryabov, M. Zvyagintseva, S. Bazanovich, Ya. V. Morozova, S. M. Radaev, A. E. Talypov, A. Grin","doi":"10.17650/1683-3295-2023-25-4-20-30","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-20-30","url":null,"abstract":"Aim. To evaluate the efficiency of systemic (intravenous) application of cryopreserved human umbilical cord blood mononuclear cells (HUCBCs) in animal models of acute contusion spinal cord injury for the restoration of hind limb motor function and formation of posttraumatic cysts using clinically significant examination methods.Materials and methods. Adult female Sprague–Dowley rats were used for the study. Severe acute contusion spinal cord injury model was performed using standard “weight‑drop” method. All samples of cryopreserved HUCBCs concentrate were prestored prior to infusion for 3 to 4 years at –196 °C. Hind limbs motor function was evaluated using open‑field technique and standard BBB testing system. Magnetic resonance scanning was performed using high‑field magnetic resonance CleanScan 7.0 T tomography (Bruker BioSpin, Germany).Results. Intravenous infusions of HUCBCs were performed on Day 1 following acute severe spinal cord injury. Motor function assessment demonstrated significant (p <0.05) improvement of hind limbs motor function (up to 40–50 %) comparing to self‑healing outcomes. Moreover, by the Days 4 and 5 after severe spinal cord injury, the volume of posttraumatic cystic cavity decreases significantly (up to 40 %) (p <0.05).Conclusion. The obtained results demonstrated that cryopreserved HUCBCs can be used as an effective source for cell therapy of acute contusion spinal cord injury.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"31 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140494340","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 : 2024-01-26DOI: 10.17650/1683-3295-2023-25-4-31-40
E. Filimonova, A. Abdilatipov, A. Kalinovskiy, E. Uzhakova, D. Rzaev
Background. Meningiomas are the most common extracerebral intracranial neoplasms. Radicality of meningioma resection largely depends on its consistency, size, and closeness to important anatomical structures. Preoperative prognosis of meningioma density plays an important role in selection of surgical access and operative inventory, general radicality of tumor resection, and neurological outcome after surgery.Aim. To determine predictors of intracranial meningioma consistency using magnetic resonance imaging and T1, T2‑mapping technique.Materials and methods. The study included 96 patients with primary meningiomas who underwent surgery at the Federal Neurosurgical Center (Novosibirsk) between 2018 and 2021. Magnetic resonance images were analyzed using calculation of the ratio between signal intensity on T1‑weighted and T2‑weighted images with subsequent group and correlation statistical analysis for comparison of T1, T2‑mapping results with clinical, histological and intraoperative data.Results. Statistically significant increase in the signal intensity and standard deviation from the mean intensity on T1, T2‑maps of psammomatous meningiomas compared to all other subtypes was observed. Additionally, positive correlation between signal intensity form meningiomas on T1, T2‑maps and intraoperative data on tumor consistency was found.Conclusion. Images obtained using T, T2‑mapping technique are as informative as traditional T2‑weighted images for evaluation of intracranial meningioma consistency. Additionally, they allow to obtain absolute intensity values. Further prospective studies are necessary for confirmation of the obtained results.
{"title":"Application of Т1, Т2‑mapping technique for evaluation of intracranial meningioma consistency","authors":"E. Filimonova, A. Abdilatipov, A. Kalinovskiy, E. Uzhakova, D. Rzaev","doi":"10.17650/1683-3295-2023-25-4-31-40","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-31-40","url":null,"abstract":"Background. Meningiomas are the most common extracerebral intracranial neoplasms. Radicality of meningioma resection largely depends on its consistency, size, and closeness to important anatomical structures. Preoperative prognosis of meningioma density plays an important role in selection of surgical access and operative inventory, general radicality of tumor resection, and neurological outcome after surgery.Aim. To determine predictors of intracranial meningioma consistency using magnetic resonance imaging and T1, T2‑mapping technique.Materials and methods. The study included 96 patients with primary meningiomas who underwent surgery at the Federal Neurosurgical Center (Novosibirsk) between 2018 and 2021. Magnetic resonance images were analyzed using calculation of the ratio between signal intensity on T1‑weighted and T2‑weighted images with subsequent group and correlation statistical analysis for comparison of T1, T2‑mapping results with clinical, histological and intraoperative data.Results. Statistically significant increase in the signal intensity and standard deviation from the mean intensity on T1, T2‑maps of psammomatous meningiomas compared to all other subtypes was observed. Additionally, positive correlation between signal intensity form meningiomas on T1, T2‑maps and intraoperative data on tumor consistency was found.Conclusion. Images obtained using T, T2‑mapping technique are as informative as traditional T2‑weighted images for evaluation of intracranial meningioma consistency. Additionally, they allow to obtain absolute intensity values. Further prospective studies are necessary for confirmation of the obtained results.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"6 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140494743","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 : 2024-01-26DOI: 10.17650/1683-3295-2023-25-4-41-48
I. A. Rudakov, A. V. Savello, V. Y. Cherebillo, A. Paltsev, U. Tsoy, E. Grineva, N. Kuritsyna
Background. Currently, the “gold standard” of differential diagnosis of Cushing’s disease is inferior petrosal sinus sampling and measurement of the adenocorticotropic hormone (ACTH) level. The studied literature data indicate a wide variability in the sensitivity and specificity of inferior petrosal sinus sampling in the range of 85–100 and 67–100 %, respectively, which can lead to an erroneous diagnosis of the source of ACTH hyperproduction and, as a consequence, to incorrect and untimely treatment.Aim.To improve the results of differential diagnosis of Cushing»s disease by using bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses.Materials and methods. Cohort single-center retro/prospective study of 70 patients with confirmed ACTH-dependent Cushing’s syndrome. For the purpose of differential diagnosis, a number of indicators were calculated: central-peripheral ratio, prolactin-normalized ACTH ratio, successful catheterization. Sampling results were evaluated in comparison with contrast-enhanced pituitary magnetic resonance imaging data and intraoperative data.Results. The study of the central-peripheral ratio showed the need to assess it simultaneously at the level of the cavernous and inferior petrosal sinuses. This approach makes it possible to significantly increase the sensitivity and specificity of the applied gradient to 93.1 and 85.7 %, respectively. Prolactin-normalized ACTH ratio is a second line predictor in the differential diagnosis of Cushing’s disease with sensitivity and specificity reaching 94.7 and 28.6 %, respectively. The gradient of successful catheterization is a reflection of possible hemodynamic features of a particular sinus, does not serve as an indicator of the correct positioning of microcatheters in the vascular bed.Conclusion. Bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses is an effective method of differential diagnosis of Cushing’s disease and ectopic ACTH-dependent syndrome.
{"title":"Bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses in the differential diagnosis of Cushing’s disease","authors":"I. A. Rudakov, A. V. Savello, V. Y. Cherebillo, A. Paltsev, U. Tsoy, E. Grineva, N. Kuritsyna","doi":"10.17650/1683-3295-2023-25-4-41-48","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-4-41-48","url":null,"abstract":"Background. Currently, the “gold standard” of differential diagnosis of Cushing’s disease is inferior petrosal sinus sampling and measurement of the adenocorticotropic hormone (ACTH) level. The studied literature data indicate a wide variability in the sensitivity and specificity of inferior petrosal sinus sampling in the range of 85–100 and 67–100 %, respectively, which can lead to an erroneous diagnosis of the source of ACTH hyperproduction and, as a consequence, to incorrect and untimely treatment.Aim.To improve the results of differential diagnosis of Cushing»s disease by using bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses.Materials and methods. Cohort single-center retro/prospective study of 70 patients with confirmed ACTH-dependent Cushing’s syndrome. For the purpose of differential diagnosis, a number of indicators were calculated: central-peripheral ratio, prolactin-normalized ACTH ratio, successful catheterization. Sampling results were evaluated in comparison with contrast-enhanced pituitary magnetic resonance imaging data and intraoperative data.Results. The study of the central-peripheral ratio showed the need to assess it simultaneously at the level of the cavernous and inferior petrosal sinuses. This approach makes it possible to significantly increase the sensitivity and specificity of the applied gradient to 93.1 and 85.7 %, respectively. Prolactin-normalized ACTH ratio is a second line predictor in the differential diagnosis of Cushing’s disease with sensitivity and specificity reaching 94.7 and 28.6 %, respectively. The gradient of successful catheterization is a reflection of possible hemodynamic features of a particular sinus, does not serve as an indicator of the correct positioning of microcatheters in the vascular bed.Conclusion. Bilateral simultaneous sampling of the cavernous and inferior petrosal sinuses is an effective method of differential diagnosis of Cushing’s disease and ectopic ACTH-dependent syndrome.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"64 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140494183","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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