Pub Date : 2023-07-10DOI: 10.17650/1683-3295-2023-25-2-106-113
A. Prirodov, P. I. Solovyeva, I. Khripun, M. Mikailov
Aim. To improve awareness of existing treatment regimens of cerebral edema by dexamethasone among doctors of various specialties (neurosurgeons, neurologists, intensive care specialists, endocrinologists). Based on scientific literature data the authors presented detailed descriptions of previously used and relevant now treatment regimens of cerebral edema by glucocorticoids (dexamethasone in particular). The authors estimated various dexamethasone prescribing schedules (2–64 mg doses fractionally used per day and one‑time 20 mg dose) for glioma tumor patients for understanding the effectiveness of therapy. The authors analyzed the risks of possible therapy by‑effects and complications. The risks were divided into the following groups: early (carbohydrate metabolic disorders, psychoemotional symptoms, hypertension, weight gain), later (exogenous hypercorticism, lipid metabolic disorders, proximal myopathy, osteoporosis, gastric and duodenal ulcer disease, immunosuppressive conditions) and withdrawal syndrome (adrenal insufficiency). In conclusion, the authors noted the ways to possibly prevent and reduce the side effects.
{"title":"The use of glucocorticoids in the treatment of cerebral edema for glioma tumour patients: Pro and Contra","authors":"A. Prirodov, P. I. Solovyeva, I. Khripun, M. Mikailov","doi":"10.17650/1683-3295-2023-25-2-106-113","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-2-106-113","url":null,"abstract":"Aim. To improve awareness of existing treatment regimens of cerebral edema by dexamethasone among doctors of various specialties (neurosurgeons, neurologists, intensive care specialists, endocrinologists). Based on scientific literature data the authors presented detailed descriptions of previously used and relevant now treatment regimens of cerebral edema by glucocorticoids (dexamethasone in particular). The authors estimated various dexamethasone prescribing schedules (2–64 mg doses fractionally used per day and one‑time 20 mg dose) for glioma tumor patients for understanding the effectiveness of therapy. The authors analyzed the risks of possible therapy by‑effects and complications. The risks were divided into the following groups: early (carbohydrate metabolic disorders, psychoemotional symptoms, hypertension, weight gain), later (exogenous hypercorticism, lipid metabolic disorders, proximal myopathy, osteoporosis, gastric and duodenal ulcer disease, immunosuppressive conditions) and withdrawal syndrome (adrenal insufficiency). In conclusion, the authors noted the ways to possibly prevent and reduce the side effects.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121422099","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 : 2023-07-10DOI: 10.17650/1683-3295-2023-25-2-60-67
K. Ezzati, Z. Rehanian, Sharhokh Yousefzadeh-Chabok, S. Ghadarjani, A. Davoudi-kiakalayeh
Objectives. To evaluate the effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation.Methods. This study was a prospective pre‑post single group study. Seventy‑one patients (42 male and 29 female) have been enrolled in the research with an age range of 20–60 (48 ± 13.41). During 48 hours before surgery, patients were examined by a physiotherapist. Pain intensity were measured by visual analogue scale, disability by oswestry index (Persian version) and sensitivity level using pressure algometer. Three month after laminectomy, the patients were re‑examined for mentioned outcomes again.Results. The majority of the patients (23 cases, 32.4 %) revealed 3 active trigger points of the muscles before surgery. 60 subjects (84.5 %) experienced a gradual onset of leg pain without a trauma history. Lumbar multifidus (74.9 %), medial gastrocnemius (73.2 %), soleus (70.4) gluteus medius (62 %) were the most involved muscles with trigger points before laminectomy. On the other hand, after laminectomy medial gastrocnemius (54.9 %), lateral gastrocnemius (53.5 %), soleus (50.7 %), multifidus (39.4 %) and quadratus lumborum (39.4 %) were the most involved muscles with trigger points. The existence of trigger points in longissimus thoracis (p = 0.04), quadratus lumborum (p = 0.001), gluteus maximus (p = 0.04) and tibialis anterior (p = 0.02) were decreased significantly after laminectomy. Pain, disability and pain pressure threshold revealed significant differences before and after surgery.Discussion. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively.Conclusion. The present study revealed that pain, disability, number and prevalence of trigger points decreased after lumbar laminectomy. Nevertheless, pressure pain threshold of trigger points increased after surgery. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively. In fact, current results showed that active trigger points should be considered before and after laminectomy surgery
{"title":"The effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation","authors":"K. Ezzati, Z. Rehanian, Sharhokh Yousefzadeh-Chabok, S. Ghadarjani, A. Davoudi-kiakalayeh","doi":"10.17650/1683-3295-2023-25-2-60-67","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-2-60-67","url":null,"abstract":"Objectives. To evaluate the effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation.Methods. This study was a prospective pre‑post single group study. Seventy‑one patients (42 male and 29 female) have been enrolled in the research with an age range of 20–60 (48 ± 13.41). During 48 hours before surgery, patients were examined by a physiotherapist. Pain intensity were measured by visual analogue scale, disability by oswestry index (Persian version) and sensitivity level using pressure algometer. Three month after laminectomy, the patients were re‑examined for mentioned outcomes again.Results. The majority of the patients (23 cases, 32.4 %) revealed 3 active trigger points of the muscles before surgery. 60 subjects (84.5 %) experienced a gradual onset of leg pain without a trauma history. Lumbar multifidus (74.9 %), medial gastrocnemius (73.2 %), soleus (70.4) gluteus medius (62 %) were the most involved muscles with trigger points before laminectomy. On the other hand, after laminectomy medial gastrocnemius (54.9 %), lateral gastrocnemius (53.5 %), soleus (50.7 %), multifidus (39.4 %) and quadratus lumborum (39.4 %) were the most involved muscles with trigger points. The existence of trigger points in longissimus thoracis (p = 0.04), quadratus lumborum (p = 0.001), gluteus maximus (p = 0.04) and tibialis anterior (p = 0.02) were decreased significantly after laminectomy. Pain, disability and pain pressure threshold revealed significant differences before and after surgery.Discussion. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively.Conclusion. The present study revealed that pain, disability, number and prevalence of trigger points decreased after lumbar laminectomy. Nevertheless, pressure pain threshold of trigger points increased after surgery. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively. In fact, current results showed that active trigger points should be considered before and after laminectomy surgery","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116727205","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 : 2023-07-10DOI: 10.17650/1683-3295-2023-25-2-20-27
V. Shimansky, V. Poshataev, G. A. Denisova, S. Tanyashin, G. Kobyakov, K. Shevchenko, V. Karnaukhov
Introduction. In the surgery of gliomas, various techniques are currently being applied that allow the maximum resection of the tumor while maintaining a good or satisfactory functional status of the patients. A rare method is intraoperative contrast‑enhanced ultrasound imaging (CEUI) of the brain substance.Aim. To present the first experience of using contrast‑enhanced ultrasound imaging CEUI in surgery of brain tumors (large hemispheres and cerebellum), as well as an assessment of the prospects of the technique in routine use in a neurosurgical hospital.Materials and methods. The features of the application of the technique CEUI, its advantages over routine ultrasound studies and the limitations identified during testing of the technique in 5 patients with various brain tumors.Results. In some cases, the CEUI allows for the intraoperative detection of a tumor, which is similar in sensitivity to magnetic resonance imaging. This greatly facilitates both the search for the neoplasm, and the formation of the optimal trajectory of surgery. In the case of benign brain tumors, ultrasound contrasting of the tumor is not always observed, but it often helps to determine the boards of the tumor with greater accuracy than the routine ultrasound search.Conclusion. The use of CEUI in the surgery of brain tumors seems to be a promising direction. A pilot study has confirmed its effectiveness, but more cases are needed to fully study the problem.
{"title":"Contrast-enchanced ultrasound navigation in glioma surgery","authors":"V. Shimansky, V. Poshataev, G. A. Denisova, S. Tanyashin, G. Kobyakov, K. Shevchenko, V. Karnaukhov","doi":"10.17650/1683-3295-2023-25-2-20-27","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-2-20-27","url":null,"abstract":"Introduction. In the surgery of gliomas, various techniques are currently being applied that allow the maximum resection of the tumor while maintaining a good or satisfactory functional status of the patients. A rare method is intraoperative contrast‑enhanced ultrasound imaging (CEUI) of the brain substance.Aim. To present the first experience of using contrast‑enhanced ultrasound imaging CEUI in surgery of brain tumors (large hemispheres and cerebellum), as well as an assessment of the prospects of the technique in routine use in a neurosurgical hospital.Materials and methods. The features of the application of the technique CEUI, its advantages over routine ultrasound studies and the limitations identified during testing of the technique in 5 patients with various brain tumors.Results. In some cases, the CEUI allows for the intraoperative detection of a tumor, which is similar in sensitivity to magnetic resonance imaging. This greatly facilitates both the search for the neoplasm, and the formation of the optimal trajectory of surgery. In the case of benign brain tumors, ultrasound contrasting of the tumor is not always observed, but it often helps to determine the boards of the tumor with greater accuracy than the routine ultrasound search.Conclusion. The use of CEUI in the surgery of brain tumors seems to be a promising direction. A pilot study has confirmed its effectiveness, but more cases are needed to fully study the problem.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131156316","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 : 2023-07-10DOI: 10.17650/1683-3295-2023-25-2-10-19
V. Bobinov, L. Rozhchenko, A. Petrov, S. Goroshchenko, E. G. Kolomin, N. K. Samochernikh, N. Y. Tukanov, K. A. Samochernikh
Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p < 0.05).Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.
介绍。脑动脉瘤血管内治疗后的术后血管造影检查结果可能不稳定，既表现为复发形成，也表现为动脉瘤囊最初不完全闭塞，闭塞程度增加。脑动脉瘤复发是一个重要的医学和社会问题，其出血风险与未手术的动脉瘤相当。目的评价采用不同血管内技术治疗脑动脉瘤的早期和远期疗效。材料和方法。本研究纳入167例脑动脉瘤患者(男48例，女119例)，年龄18 ~ 75岁，于2013 ~ 2016年在以A. L. Polenov教授命名的俄罗斯神经外科研究所第三神经外科采用血管内技术进行手术。患者平均年龄52±12岁，最小年龄18岁，最大年龄75岁。纳入研究的患者血管内治疗方法的选择是基于动脉瘤的解剖形态学和形态特征，并考虑动脉瘤病程的长短。对脑动脉瘤患者血管内治疗后对照血管造影检查资料的研究表明，在术后远段时间内，动脉瘤的闭塞程度可能与最初达到的程度不同。术后6个月孤立闭塞动脉瘤复发率为13.1%，12个月为31.7%，36个月为22.3%，平均为22.5% (p < 0.05)。在选择最佳手术策略治疗脑动脉瘤患者时，个性化的方法可以实现稳定的根治性动脉瘤闭塞，减少术后并发症的发生率和术后长期内动脉瘤的复发。
{"title":"Early and long-term results of endovascular treatment of cerebral aneurysms","authors":"V. Bobinov, L. Rozhchenko, A. Petrov, S. Goroshchenko, E. G. Kolomin, N. K. Samochernikh, N. Y. Tukanov, K. A. Samochernikh","doi":"10.17650/1683-3295-2023-25-2-10-19","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-2-10-19","url":null,"abstract":"Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p < 0.05).Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130245510","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 : 2023-03-30DOI: 10.17650/1683-3295-2023-25-1-103-112
Zaur B. Khadzhiev, A. Grin
Background. In the structure of severe combined trauma, injuries to the pelvic bones, especially the sacrum, are relatively rare but increase steadily with the scientific and technological progress and the urbanization. Despite the widespread use of modern diagnostic methods, such as computer and magnetic resonance imaging, and the ubiquity of X‑ray diagnostics, sacral fractures are diagnosed not in all patients or not in full. In 50 % of patients, sacral fractures are not diagnosed during the initial examination, including anteroposterior X‑ray examination. In addition, in 30 % of the patients, sacral fractures are recognized on a pelvic X‑ray film incorrectly, and the long‑term outcomes of their treatment are unsatisfactory from 30 to 60 % of the cases.Aim. To analyze scientific published sources on the issues of diagnosis, clinical picture, and treatment of patients with severe combined trauma and unstable sacral fractures.Materials and methods. The data of 232 domestic and foreign publications from 1971 to 2020. We present the epidemiology of combined trauma and unstable sacral fractures, consider various classifications, and describe the clinical course and tactics in conservative and surgical treatment of vertically unstable fractures in the posterior pelvic ring.Results. Many foreign publications describe both diagnostics and various methods of treatment for unstable pelvic ring injuries. The publications cover various aspects of diagnosis, clinical course, management tactics, extent and timing of surgery, and conservative treatment for sacral fractures. However, only a few publications in Russian discuss features of diagnostic search, the timing and extent of surgery, as well as the choice of the final tactics to treat patients with sacral fractures.Conclusions. It is necessary to study the problem of diagnosis and treatment of severe combined trauma and vertically unstable fractures of the posterior pelvic ring to develop optimal diagnostic algorithms and final treatment tactics aimed at reduction of the frequency of errors, complications, and deaths, and at improvement in the quality of life of such patients.
{"title":"Diagnosis, surgical and conservative treatment of unstable sacral fractures (literature review)","authors":"Zaur B. Khadzhiev, A. Grin","doi":"10.17650/1683-3295-2023-25-1-103-112","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-103-112","url":null,"abstract":"Background. In the structure of severe combined trauma, injuries to the pelvic bones, especially the sacrum, are relatively rare but increase steadily with the scientific and technological progress and the urbanization. Despite the widespread use of modern diagnostic methods, such as computer and magnetic resonance imaging, and the ubiquity of X‑ray diagnostics, sacral fractures are diagnosed not in all patients or not in full. In 50 % of patients, sacral fractures are not diagnosed during the initial examination, including anteroposterior X‑ray examination. In addition, in 30 % of the patients, sacral fractures are recognized on a pelvic X‑ray film incorrectly, and the long‑term outcomes of their treatment are unsatisfactory from 30 to 60 % of the cases.Aim. To analyze scientific published sources on the issues of diagnosis, clinical picture, and treatment of patients with severe combined trauma and unstable sacral fractures.Materials and methods. The data of 232 domestic and foreign publications from 1971 to 2020. We present the epidemiology of combined trauma and unstable sacral fractures, consider various classifications, and describe the clinical course and tactics in conservative and surgical treatment of vertically unstable fractures in the posterior pelvic ring.Results. Many foreign publications describe both diagnostics and various methods of treatment for unstable pelvic ring injuries. The publications cover various aspects of diagnosis, clinical course, management tactics, extent and timing of surgery, and conservative treatment for sacral fractures. However, only a few publications in Russian discuss features of diagnostic search, the timing and extent of surgery, as well as the choice of the final tactics to treat patients with sacral fractures.Conclusions. It is necessary to study the problem of diagnosis and treatment of severe combined trauma and vertically unstable fractures of the posterior pelvic ring to develop optimal diagnostic algorithms and final treatment tactics aimed at reduction of the frequency of errors, complications, and deaths, and at improvement in the quality of life of such patients.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126699987","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 : 2023-03-30DOI: 10.17650/1683-3295-2023-25-1-95-102
A. Nevedrov, D. I. Kelban, I. Aleynikova, P. Ivanov, A. Grin, K. V. Svetlov
Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.
{"title":"Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)","authors":"A. Nevedrov, D. I. Kelban, I. Aleynikova, P. Ivanov, A. Grin, K. V. Svetlov","doi":"10.17650/1683-3295-2023-25-1-95-102","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-95-102","url":null,"abstract":"Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131444667","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 : 2023-03-30DOI: 10.17650/1683-3295-2023-25-1-78-84
D. M. Khatomkin, A. Vorobev, I. A. Vorobev, N. Komissarova, A. V. Kobelev
Background. Subdural empyemas are accumulation of pus between the dura mater and the arachnoid mater of the brain. They represent 12–25 % of all intracranial purulent‑inflammatory diseases. 70–80 % of them are located convexitaly and 10–20 % in the area of the falx cerebri. A spread of pus on the tentorium cerebellum occurs rare. Without timely treatment, that includes massive therapy with antibiotics and drainage of the subdural empyema, most of the patients die in the result of progression of the secondary purulent meningoencephalitis and dislocation of the brain.Аim. To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. At the time of discharge from the neurosurgical department 16 days after the operation complete regress of the general infectious and meningeal syndrome was observed.Results. On control examination 44 days after the surgery the patient’s condition was normal and he had no neurolog ical deficit. On the series of MRI scans preformed 6 months latter, after the cranioplasty, no remnants of the subdural empyema were revealed.Conclusions. This clinical case demonstrates the effectiveness of the prolonged continuous flow drainage in combination with systemic antobioticotherapy and elimination of the primary source of infection within the frontal sinus in treatment of the large and deeply situated subdural empyema of rare falcotentorial localization.
{"title":"Surgical treatment of a patient with purulent frontal sinusitis and falcotentorial empyema","authors":"D. M. Khatomkin, A. Vorobev, I. A. Vorobev, N. Komissarova, A. V. Kobelev","doi":"10.17650/1683-3295-2023-25-1-78-84","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-78-84","url":null,"abstract":"Background. Subdural empyemas are accumulation of pus between the dura mater and the arachnoid mater of the brain. They represent 12–25 % of all intracranial purulent‑inflammatory diseases. 70–80 % of them are located convexitaly and 10–20 % in the area of the falx cerebri. A spread of pus on the tentorium cerebellum occurs rare. Without timely treatment, that includes massive therapy with antibiotics and drainage of the subdural empyema, most of the patients die in the result of progression of the secondary purulent meningoencephalitis and dislocation of the brain.Аim. To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. At the time of discharge from the neurosurgical department 16 days after the operation complete regress of the general infectious and meningeal syndrome was observed.Results. On control examination 44 days after the surgery the patient’s condition was normal and he had no neurolog ical deficit. On the series of MRI scans preformed 6 months latter, after the cranioplasty, no remnants of the subdural empyema were revealed.Conclusions. This clinical case demonstrates the effectiveness of the prolonged continuous flow drainage in combination with systemic antobioticotherapy and elimination of the primary source of infection within the frontal sinus in treatment of the large and deeply situated subdural empyema of rare falcotentorial localization.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128023625","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 : 2023-03-30DOI: 10.17650/1683-3295-2023-25-1-85-94
R. S. Martynov, A. Savello, A. N. Savchuk, K. Babichev, A. I. Kiskaev, D. V. Svistov
Introduction. The etiology and pathogenesis of cerebral aneurysms are diverse. The rare cause of cerebral aneurysms occurrence is cardioembolism in cases of heart tumors, in particular in myxoma. Cardiac myxoma (from Latin muxa, mucus) is the most common (about 50 %) benign tumor of heart. With untimely diagnosis and absence of the disease treatment, embolisms in cerebral vessels may occur with typical symptoms of ischemic stroke as well as in some cases the myxomal aneurysms may develop. There are several theories of their origin. The myxomal aneurysms of cerebral vessels are more common in women and in the vast majority of cases they develop in carotid basins. In a quarter of cases, the disease onsets as intracranial hemorrhage caused by rupture of an oncotic (myxomal) aneurysm, that significantly exceeds the frequency of ruptures (1–3 % per year) in cases of “normal” bifurcation‑hemodynamic intracranial aneurysms. The mortality rate is 3.4 %. The majority (80 %) of ruptures were observed within 2 years after the diagnosis of cardiac myxoma, and in half (48.6 %) of cases clinically significant episodes of embolism were noted. Timely treatment can prevent the hemor rhagic type of course of these aneurysms. Various methods of treatment are described in the literature: different options for surgical eradication as well as the possibilities of chemotherapy and radiation exposure.Aim. To present a case of successful radical reconstructive endovascular treatment of patient with distal cerebral aneurysm associated with cardiac myxoma, combined with presence of multiple cavernous malformations and also to highlight issues of diagnosis, differential diagnosis and existing treatment options for these diseases.Clinical observation. The article presents a clinical observation of multiple aneurysms associated with myxoma of the heart in combination with multiple cavernous angiomas of the brain. The possibility of reconstructive eradication of distal aneurysm after its transformation from fusiform to saccular is demonstrated. The etiology and pathogenesis of occurrence, the nuances of differential diagnosis, possible methods and the algorithm for choosing a method for treating brain aneurysms associated with myxomas are reflected. The patient underwent reconstructive aneurysm shutdown by embolization with microspirals, which became possible due to the anatomical shape that favored this type of treatment. Conversion to destructive intervention was not required. Due to the natural course of the disease, the patient remains at risk of progression of a distal aneurysm in the basin of the same artery, and therefore it will be observed in dynamics.Conclusion. All patients with cardiac myxomas, both before and in dynamics after their removal, are recommended to perform noninvasive visualization of brain vessels for verification of such complication as metastatic (myxomal) aneurysms. The prognosis in most patients with multiple intracranial aneurysms associated with
{"title":"Reconstructive endovascular treatment of distal cerebral aneurysm associated with cardiac myxoma","authors":"R. S. Martynov, A. Savello, A. N. Savchuk, K. Babichev, A. I. Kiskaev, D. V. Svistov","doi":"10.17650/1683-3295-2023-25-1-85-94","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-85-94","url":null,"abstract":"Introduction. The etiology and pathogenesis of cerebral aneurysms are diverse. The rare cause of cerebral aneurysms occurrence is cardioembolism in cases of heart tumors, in particular in myxoma. Cardiac myxoma (from Latin muxa, mucus) is the most common (about 50 %) benign tumor of heart. With untimely diagnosis and absence of the disease treatment, embolisms in cerebral vessels may occur with typical symptoms of ischemic stroke as well as in some cases the myxomal aneurysms may develop. There are several theories of their origin. The myxomal aneurysms of cerebral vessels are more common in women and in the vast majority of cases they develop in carotid basins. In a quarter of cases, the disease onsets as intracranial hemorrhage caused by rupture of an oncotic (myxomal) aneurysm, that significantly exceeds the frequency of ruptures (1–3 % per year) in cases of “normal” bifurcation‑hemodynamic intracranial aneurysms. The mortality rate is 3.4 %. The majority (80 %) of ruptures were observed within 2 years after the diagnosis of cardiac myxoma, and in half (48.6 %) of cases clinically significant episodes of embolism were noted. Timely treatment can prevent the hemor rhagic type of course of these aneurysms. Various methods of treatment are described in the literature: different options for surgical eradication as well as the possibilities of chemotherapy and radiation exposure.Aim. To present a case of successful radical reconstructive endovascular treatment of patient with distal cerebral aneurysm associated with cardiac myxoma, combined with presence of multiple cavernous malformations and also to highlight issues of diagnosis, differential diagnosis and existing treatment options for these diseases.Clinical observation. The article presents a clinical observation of multiple aneurysms associated with myxoma of the heart in combination with multiple cavernous angiomas of the brain. The possibility of reconstructive eradication of distal aneurysm after its transformation from fusiform to saccular is demonstrated. The etiology and pathogenesis of occurrence, the nuances of differential diagnosis, possible methods and the algorithm for choosing a method for treating brain aneurysms associated with myxomas are reflected. The patient underwent reconstructive aneurysm shutdown by embolization with microspirals, which became possible due to the anatomical shape that favored this type of treatment. Conversion to destructive intervention was not required. Due to the natural course of the disease, the patient remains at risk of progression of a distal aneurysm in the basin of the same artery, and therefore it will be observed in dynamics.Conclusion. All patients with cardiac myxomas, both before and in dynamics after their removal, are recommended to perform noninvasive visualization of brain vessels for verification of such complication as metastatic (myxomal) aneurysms. The prognosis in most patients with multiple intracranial aneurysms associated with","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117034887","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 : 2023-03-29DOI: 10.17650/1683-3295-2023-25-1-36-46
Background. Acromegaly is a rare disease associated with insulin‑like growth factor 1 hyperproduction due to the presence of pituitary adenoma in the patient. The first‑line treatment of such patients is surgical removal of the formation in order to normalize hormonal status. The main predictors of the ineffectiveness of surgical treatment and relapse of the disease are large tumor size, tumor invasion into the cavernous sinus, and high preoperative levels of growth hormone, as well as Ki‑6 % expression. The search for additional risk factors for disease recurrence, which according to various sources is approximately 30 % after primary surgical treatment, is an urgent task for researchers. In our work, we studied the intraoperative characteristics of the tumor, size of pituitary adenomas according to preoperative magnetic resonance imaging of the brain, degree of invasion of the tumor into the cavernous sinus according to the Knosp classification and compared them with disease outcomes after a year of follow‑up after surgical treatment.Aim. To identify new markers of aggressive progression of pituitary tumors.Materials and methods. A retrospective analysis of medical documentation, protocols of operations of 90 patients aged between 19 and 73 years with the diagnosis of growth hormone‑secreting pituitary adenoma was performed. The dia gnosis was confirmed based on clinical picture, laboratory and instrumental examination methods. All patients underwent endoscopic transsphenoidal removal of pituitary adenoma by one surgeon in one medical institution between 2017 and 2019.Results. Intraoperative characteristics of the tumor, such as the color of the solid component, density, degree of vascularization were compared with the results of laboratory and instrumental data, as well as the results of surgical treatment after a year of follow‑up.Conclusion. Such intraoperative characteristics of growth hormone‑secreting pituitary adenomas as the purplish‑gray color of the solid component, high vascularization, as well as dense‑elastic consistency of the tumor, can be considered high risk factors for continued tumor growth in the first 6 months after surgical treatment or relapse of the disease during a year of follow‑up.
{"title":"Intraoperative characteristics of somatotropinomas","authors":"","doi":"10.17650/1683-3295-2023-25-1-36-46","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-36-46","url":null,"abstract":"Background. Acromegaly is a rare disease associated with insulin‑like growth factor 1 hyperproduction due to the presence of pituitary adenoma in the patient. The first‑line treatment of such patients is surgical removal of the formation in order to normalize hormonal status. The main predictors of the ineffectiveness of surgical treatment and relapse of the disease are large tumor size, tumor invasion into the cavernous sinus, and high preoperative levels of growth hormone, as well as Ki‑6 % expression. The search for additional risk factors for disease recurrence, which according to various sources is approximately 30 % after primary surgical treatment, is an urgent task for researchers. In our work, we studied the intraoperative characteristics of the tumor, size of pituitary adenomas according to preoperative magnetic resonance imaging of the brain, degree of invasion of the tumor into the cavernous sinus according to the Knosp classification and compared them with disease outcomes after a year of follow‑up after surgical treatment.Aim. To identify new markers of aggressive progression of pituitary tumors.Materials and methods. A retrospective analysis of medical documentation, protocols of operations of 90 patients aged between 19 and 73 years with the diagnosis of growth hormone‑secreting pituitary adenoma was performed. The dia gnosis was confirmed based on clinical picture, laboratory and instrumental examination methods. All patients underwent endoscopic transsphenoidal removal of pituitary adenoma by one surgeon in one medical institution between 2017 and 2019.Results. Intraoperative characteristics of the tumor, such as the color of the solid component, density, degree of vascularization were compared with the results of laboratory and instrumental data, as well as the results of surgical treatment after a year of follow‑up.Conclusion. Such intraoperative characteristics of growth hormone‑secreting pituitary adenomas as the purplish‑gray color of the solid component, high vascularization, as well as dense‑elastic consistency of the tumor, can be considered high risk factors for continued tumor growth in the first 6 months after surgical treatment or relapse of the disease during a year of follow‑up.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116530604","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 : 2023-03-29DOI: 10.17650/1683-3295-2023-25-1-70-77
N. I. Romanova, I. Zubatkina, P. Ivanov
Background. Breast cancer contributed to 11.8 % of all the oncological diseases detected in Russia in 2020 and to 21.7 % of tumors detected among women. The frequency of brain metastases is estimated at 13–32 %. It is known that HER2 positive and triple negative breast cancers metastasize to the brain more frequently.Aim. To present the case of stereotactic high‑dose irradiation for a large brainstem metastasis from HER2 positive breast cancer and re‑irradiation of the recurrence.Materials and methods. Analysis of the results of stereotactic irradiation for a large brainstem metastasis from HER2 positive breast cancer and re‑irradiation of the recurrence with a local control over five years was performed.Results. The local control after five years did not show any signs of tumor progression or post‑radiation necrosis. The patient’s Karnofsky Performance Status was estimated at 100 points.Conclusions. The case shows the necessity of highly conformal stereotactic dose delivery to the tumor, precise determination of tumor boundaries on high resolution thin slice magnetic resonance imaging, verification of recurrence using metabolic studies and hypofractionated dose delivery. It remains open whether and to what extent target therapy may contribute to local control.
{"title":"High-dose stereotactic radiosurgery for large brainstem metastasis and its recurrence treatment","authors":"N. I. Romanova, I. Zubatkina, P. Ivanov","doi":"10.17650/1683-3295-2023-25-1-70-77","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-70-77","url":null,"abstract":"Background. Breast cancer contributed to 11.8 % of all the oncological diseases detected in Russia in 2020 and to 21.7 % of tumors detected among women. The frequency of brain metastases is estimated at 13–32 %. It is known that HER2 positive and triple negative breast cancers metastasize to the brain more frequently.Aim. To present the case of stereotactic high‑dose irradiation for a large brainstem metastasis from HER2 positive breast cancer and re‑irradiation of the recurrence.Materials and methods. Analysis of the results of stereotactic irradiation for a large brainstem metastasis from HER2 positive breast cancer and re‑irradiation of the recurrence with a local control over five years was performed.Results. The local control after five years did not show any signs of tumor progression or post‑radiation necrosis. The patient’s Karnofsky Performance Status was estimated at 100 points.Conclusions. The case shows the necessity of highly conformal stereotactic dose delivery to the tumor, precise determination of tumor boundaries on high resolution thin slice magnetic resonance imaging, verification of recurrence using metabolic studies and hypofractionated dose delivery. It remains open whether and to what extent target therapy may contribute to local control.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114242578","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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