Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko最新文献

Background. Although the concepts of «complex aneurysm» and «technically complex aneurysm» are widely used at present, there is no generally accepted definition. Moreover, the criteria are often subjective. Depending on the parameters included, complex aneurysms comprise 5-9.7% of all patients with cerebral aneurysms [1, 2]. Complex aneurysms have higher risk of complications, whose accurate assessment is difficult. In case of unruptured aneurysms, analysis of this risk is of particular importance.

Objective: To develop the microsurgical complexity index in the treatment of unruptured aneurysms for objective assessment of complexity of microsurgical treatment and prediction of complications.

Material and methods: The study included 850 patients with a single unruptured aneurysm who underwent microsurgical treatment. Postoperative outcomes and incidence of various complications were analyzed depending on anatomical and morphological characteristics of aneurysm.

Results: We developed the microsurgical complexity index for the treatment of unruptured aneurysms and appropriate web application (www.isam.rf). Patients with severe neurological disorders at discharge comprised 2.5%, and mortality rate was 0.47%. New neurological deficit after surgery occurred in 9.3% of cases. Moderate and severe in-hospital complications occurred in 8.6% of cases. Non-radical exclusion of aneurysm was observed in 4.1% of cases. In case of complexity index «0», the incidence of various complications was lower compared to the group as a whole by 1.8-5.7%, index «1» - by 0.1-2.7%, index «2». The incidence of in-hospital complications Clavien-Dindo grade III-V was lower by 0.3%. The incidence of functional status mRS score 4-6 did not differ from the group as a whole, and the incidence of other complications was higher by 0.9-3.6%. In case of complexity index «3», the incidence of all complications was higher by 0.6-12.8%, index «4» - by 10.8-22.6%, index «5-6» - by 3.9-22.7%.

Conclusion: Original index may be valuable for more objective assessment of the risks of microsurgical treatment of aneurysms depending on anatomical and morphological characteristics and stratification of aneurysms according to their complexity. Aneurysms with index ≥3 may be classified as a group of complex aneurysms.

Despite modern advances in neurosurgery, treatment of intramedullary spinal cord tumors is still associated with postoperative neurological impairment and high incidence of adverse outcomes. Intraoperative neurophysiological monitoring allows real-time functional assessment of spinal cord conduction pathways and accurate tumor resection. Currently, concomitant monitoring of somatosensory and motor evoked potentials, as well as D-wave is the most common. This excludes damage to both sensory and motor pathways. In modern literature, there are some differences in methods of intraoperative neurophysiological monitoring, such as sensitivity and specificity of the method, criteria of «alarm» during surgical treatment of intramedullary tumors and correlation of neurophysiological monitoring parameters with postoperative neurological status of patients.

Objective: To study the structure, incidence and risk factors of perioperative complications in children with craniosynostosis (CS).

Material and methods: A systematic searching of data was performed for analysis of perioperative complications and adverse events following surgical correction of CS in patients younger 24 months.

Results. a: Systematic review included 33 manuscripts. The overall incidence of complications and adverse events was 9.8%. In patients after endoscopic surgeries, this rate was 7.2%, whereas open reconstructive surgeries were followed by 13.5% morbidity.

Conclusion: The most common surgical complications in pediatric craniosynostosis surgery were intraoperative blood loss requiring transfusion (35.7%), dural tears (3.8%), cerebrospinal fluid leaks (0.7%), hematomas (1.6%), and surgical site infections (1.6%). Non-surgical complications included non-surgical infections (1.1%), respiratory (1.2%) and neurological disturbances (0.5%). Fever (3.4%) is an undesirable phenomenon and can aggravate postoperative period after surgery for CS.

Objective: To study the dynamics of permeability of the blood-brain barrier (BBB) after focused ultrasound (FUS) thalamotomy in patients with tremor of different origin through visualization phenomena, assessment of the tendency of contrast accumulation level change at MRI in coagulation necrosis focus over different time intervals.

Material and methods: The study included 10 patients (8 - with Parkinson's disease, 2 - with essential tremor). MRI of the brain was performed before the procedure, MRI of the brain with contrast enhancement («Gadobutrol») was carried out after 2 and 24 hours, 1, 3, 6 and 12 months from FUS thalamotomy. The volume and nature of contrast accumulation in the impact area were evaluated.

Results: Observations show that the performance of FUS thalamotomy leads to a temporary impairment of the BBB permeability. This is confirmed by the data of dynamic accumulation of contrast substance in MRI in the area of coagulation necrosis.

Conclusion: The analysis of the dynamic changes of volume and patterns of accumulation of contrast substance in MRI in the area of coagulation necrosis after FUS thalamotomy was performed during the study. The obtained data demonstrate almost complete absence of contrast enhancement 24 hours after intervention, that may indicate a partial restoration of the structural-functional integrity of BBB after its transient disruption in the early postoperative period.

Combat injuries to the spine and spinal cord refer to rare, but some of the most severe. Currently, there is a need to improve the treatment and rehabilitation of patients with injuries to the spine and spinal cord. However, the complicated course of the wound infection can become a critical factor influencing the treatment outcome.

Objective: To analyze the structure of complications in the early period and determine the factors that have the greatest influence on the incidence of their development in gunshot wounds and closed injuries to the spine and spinal cord under modern conditions.

Material and methods: The work analyzed the results of a prospective examination and treatment of 300 injured subjects, who received medical care at various stages of medical evacuation. A total of 65.6% of the injured had gunshot wounds, 34.4% - closed injuries to the spine. Mine blast injuries were the most common - 88%, and missile wounds - 12%. Age of the patients ranged from 18 to 59 years, median age was 34. Most observed patients (79.6%) had combined injuries.

Results: The incidence of surgical complications during the treatment in the Vishnevsky Central Military Clinical Hospital in the group of gunshot wounds amounted to 28%, in closed injuries - 7.8%, complications of the wound infection 42.4% and 17.6%, respectively. Liquorrhea has been observed only in the group with gunshot wounds in 5.2% of cases. The instability of surgical hardware has not been recorded in any case. The highest incidence of purulent-septic complications was recorded in the group with gunshot wounds and amounted to 26%, and in the group with closed injuries - 9%. Purulent meningitis has been developed in 3% of patients, all of them had gunshot wounds to the spine. Postoperative wound pyogenesis has been noted in 2.7%. Overall mortality was 6%.

Conclusion: The combination of the damage and severe nature of the injury are common for gunshot wounds and closed injury to the spine and spinal cord. The risk of surgical complications (purulent-septic, postoperative liquorrhea) for patients with gunshot wounds is higher. More frequent development of complications of wound disease, namely pulmonary, urological, infectious (pneumonia), is typical. Wound liquorrhea also statistically significantly increases the possibility of surgical complications.

Surgery of meningiomas of the craniocervical region is one of the most difficult parts of neurosurgery due to the closeness of the brainstem, caudal group of the cranial nerves (CNs) and vertebral artery. According to the literature, suffering of the caudal group of CNs is between 20 and 55% according to different authors. In their dysfunction, the recovery of CNs is long-term and requires joint efforts by both the medical team and the patient and his family.

Objective: To demonstrate the dynamics of the restoration of CNs functions (over 12 years) in patient after resection of the ventrolateral craniocervical meningioma.

Material and methods: The article describes a clinical case of patient with ventrolateral meningioma of the craniocervical region. The tumor was resected (Simpson II) from a posterolateral access with transcondylar extension.

Results: The dynamics of caudal CNs recovery over 12 years has been traced and presented. In this clinical case, the main restoration of caudal CNs function has been observed during the first 6 months after surgery and remained unchanged thereafter.

Conclusion: Based on the literature data and presented clinical observation, it appears that the resection of meningiomas from the lower third of the clivus is predictably associated with a high risk of caudal CNs dysfunction, that should be considered when planning an operation and a postoperative rehabilitation program.

Complexity of neurosurgery for intracerebral frontal lobe tumors is determined by adjacent cortical and subcortical functional zones and white matter fibers connecting these areas and responsible for various neurocognitive functions. When removing frontal lobe gliomas in dominant hemisphere, neurosurgeons are forced to interact with speech functional system. Recent studies have shown that neuroanatomical basis of speech is more complex, multicomponent and integrated system than previously thought. Postulates of classical model of speech analyzer organization do not coincide with results of modern researches in speech physiology and pathophysiology. According to modern neuroscience, cognitive functions of the brain are realized by distributed groups of connected and synchronized networks of neurons rather separate neural centers as previously assumed. To understand such a complex cognitive system as speech, it is necessary to recognize not only elementary components of this system, but also their interaction and appropriate new properties. This review systematizes modern ideas about organization of speech functional system from the perspective of neurosurgery for glial frontal lobe tumors.

Brain metastases occur in approximately 20% of all cancer patients. Stereotactic radiosurgery alone and in combination with surgical resection is one of the approaches to treating patients with brain metastases.

Objective: To evaluate the effectiveness of stereotactic radiosurgery regarding local control, overall survival and complications; to compare stereotactic radiosurgery alone and preoperative stereotactic radiotherapy.

Material and methods: A retrospective study included 85 patients with single brain metastasis. The first group comprised 45 patients who underwent stereotactic radiosurgery, while the second group included 40 patients who underwent preoperative stereotactic radiotherapy and subsequent surgical treatment. Mean age was 59 and 56 years (p=0.2), radiation volume - 4.4 and 15.9 cm³, respectively (p<0.05).

Results: Local growth control after preoperative stereotactic radiotherapy followed by resection was 100%, 97.5%, and 87.5% after 3, 6, and 12 months, respectively. After stereotactic radiotherapy alone, these values were 100%, 95.6% and 88.9%, respectively (p=0.4). One-year survival was 87.5% after preoperative radiotherapy and 64.4% after stereotactic radiosurgery alone (p<0.05). Among 85 patients, 16 (18.8%) ones had long-term surgical and post-radiation complications.

Conclusion: Stereotactic radiotherapy alone is effective. However, there are limitations in tumor size (up to 2.5 cm) and volume (9.5 cm³). Preoperative stereotactic radiotherapy followed by surgical resection is advisable for larger tumors (up to 4.5 cm and 18.9 cm³) with high rates of overall survival and local growth control.

In 2021, a new type of tumor was defined according to the new WHO classification (high-grade astrocytoma with piloid features, HGAP). Morphological and neuroimaging differences of HGAP from pilocytic astrocytoma complicate diagnosis. Now, significant detection of this tumor is possible only using molecular genetic testing, in particular, methylation profile analysis.

Objective: To present a patient with HGAP and perform a systematic review of studies devoted to adults with HGAP regarding clinical course, diagnosis, protocols and treatment outcomes.

Material and methods: Selection of studies was carried out in accordance with the PRISMA recommendations. The authors analyzed the studies independently of each other. All data were systematized. A case report was described jointly with attending physicians and pathologists.

Results and discussion: HGAP is characterized by rapid progression and resistance to therapy. This case illustrates the importance of awareness of neurosurgeons and necessitates molecular genetic tests to identify this group of tumors.

Conclusion: HGAP is a rare and aggressive tumor. Treatment algorithm for such patients has not yet been developed. The world experience of treatment is presented by individual series. Analysis of methylation profile is necessary for patients with atypical course of tumors similar to pilocytic astrocytoma.

Introduction: The majority of meningiomas - benign tumors with an extremely low metastasis tendency. Only singular observations of extracranial metastasis of WHO Grade I benign meningiomas are described in the literature. Despite the intensive study of meningiomas' molecular biology, there are currently no reliable markers indicating the possibility of their metastasis.

Objective: To describe the clinical case report of a patient with meningothelial meningioma of the wings of the sphenoid bone and extracranial metastasis into the pulmonary parenchyma.

Material and methods: Patient with sphenopetroclival meningioma on the left was observed in the clinic. Operations were performed in 2003, 2005 and 2008. In 2009, radiation treatment of the tumor residue in the medial portions of the middle cranial fossa and on the clivus was carried out in a total focal dose of 56.0 Gy. In 2022, multiple lung metastases were detected in presence of a satisfactory condition on CT performed due to suspicion of viral pneumonia.

Results: Histological diagnosis of primary tumor and thoracoscopically resected metastase - WHO Grade I meningothelial meningioma, Ki-67 labeling index amounted to 3%. As of May 2025, the patient's well-being is satisfactory, the Karnofsky index - 80, on the ECOG scale - 1. The primary tumor after radiation treatment in 2009 is stable, metastases in the lungs also have not been progressing since detection in 2022 despite the absence of special treatment.

Conclusion: The presented clinical observation confirms the possibility of distant metastasis of WHO Grade I meningioma and a relatively favorable course of metastatic disease in this case.