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

Throughout history, physicians have attempted to alleviate suffering of patients with trigeminal neuralgia. However, treatment was ineffective because pathogenesis of disease was unclear. Nevertheless, history of neuralgia shows that pioneering observations made by experienced clinicians led to development of methods that at least partially alleviated pain despite unclear etiopathogenesis. Improvement of treatment methods has evolved from religious rituals to vascular decompression of trigeminal nerve.

Objective: To evaluate the effectiveness of neurolysis combined with chronic electrical stimulation in patients with post-traumatic sciatic neuropathy.

Material and methods: A prospective randomized study enrolled 14 patients with post-traumatic sciatic neuropathy. Patients were divided into two groups: group A (neurolysis+chronic electrical stimulation) and group B (neurolysis). Group A included 6 patients. All ones had severe neurogenic pain syndrome (VAS score 7.16±0.75). In five patients, pain syndrome was accompanied by muscle weakness. Group B included 8 patients with severe neurogenic pain syndrome (VAS score 7.42±0.78). Muscle weakness was noted in seven cases. We assessed pain and muscle strength before surgery, in early postoperative period, 3, 6 and 12 months after surgery.

Results: In group A, pain decreased in all cases (from 7.16±0.75 points before surgery to 2.33±1.36 points after 12 months). All patients with muscle weakness experienced higher muscle strength and range of voluntary movements after 12 months. In group B, pain decreased only in 4 out of 8 patients. Dynamics of pain ranged from 7.42±0.78 points before surgery to 5±3.02 points after 12 months. Higher muscle strength and range of movements were observed in only two patients.

Conclusion: Neurolysis combined with chronic electrical stimulation is followed by better outcomes in patients with post-traumatic sciatic neuropathy. Chronic peripheral electrical stimulation probably has an effect on recovery of motor functions.

Objective: To identify research trends in glioma radiomics using topic modeling, to analyze development of this field and to determine areas with potential clinical and scientific significance.

Material and methods: A comprehensive bibliometric and thematic analysis of literature data on glioma radiomics published between 2014 and 2024 was conducted. We screened the PubMed database using appropriate keywords. After preliminary screening of publications, we used topic modeling and bibliometric analysis to identify key research areas and development trends.

Results: The number of publications devoted to glioma radiomics increased between 2014 and 2024. The key research areas included segmentation and extraction of features of glioma radiographic images, validation and reproducibility of machine learning models, molecular classification of gliomas, and survival prediction. These studies highlight the importance of model reproducibility and application of radiomics together with genomic data analysis and artificial intelligence methods.

Discussion: Glioma radiomics demonstrates significant potential for clinical practice, particularly when integrated with molecular and genomic data. Despite rapid development of this field, there are challenges with model reproducibility and protocol standardization limiting their widespread adoption. Available studies demonstrate the need to use multiple-center data and improve interpretability of radiomics features. Future studies should focus on significant clinically applicable models and better integration of radiomics with artificial intelligence for personalized medicine.

Conclusion: Glioma radiomics is advancing towards creation of more significant and clinically applicable models. Validation of models on diverse datasets and integration of radiomics with molecular and genomic methods are key areas of future research. Topic modeling enabled identification of key research topics reflecting current state and promising areas of radiomics application in glial tumor research.

Augmented reality (AR) is a promising area in microsurgical treatment of cerebrovascular pathologies that can significantly facilitate preoperative planning and intraoperative understanding of anatomy.

Objective: To describe AR-assisted neuronavigation in microsurgical treatment of intracranial aneurysms, arteriovenous malformations and cavernomas; to evaluate accuracy and applicability of AR-assisted neuronavigation.

Material and methods: The study involved 22 patients with cerebral aneurysms, arteriovenous and cavernous malformations. Microsoft Hololens 2 HMD glasses and «Medgital» software for AR navigation were used. Accuracy of registration (TRE and FRE) and time for preoperative preparation were evaluated.

Results. mean: TRE when using QR code was 0.6±0.2 cm, when combining through craniometric points - 1.4±0.6 cm. Time for preoperative image processing was 24.7±5.1 minutes, application setup in the operating theatre - 1.6±0.2 minutes. Combination using QR code provided higher accuracy of registration compared to craniometric points. AR-assisted navigation improved visualization and planning of surgeries for aneurysms, arteriovenous malformations, microvascular anastomoses and cavernous angiomas.

Conclusion: AR-assisted navigation is an innovative method with specific advantages that can potentially improve microsurgical treatment of cerebrovascular diseases. Further research is needed to confirm these findings and develop AR technology in neurosurgery.

Background: The primary objective of neurosurgical intervention for central nervous system tumors is a balance between optimal tumor resection and minimal postoperative neurological impairment. Intraoperative neurophysiological monitoring is essential in safeguarding somatosensory tracts during surgery. Virtually the only tool for continuous monitoring of sensory pathways is registration of peripheral somatosensory evoked potentials (SSEPs). However, this method has some limitations.

Objective: To increase the quality of intraoperative SSEP monitoring in surgical treatment of brainstem and spinal cord tumors.

Material and methods: To ensure continuous monitoring of sensory pathway function in brainstem and spinal cord surgery, we modified the method for monitoring of SSEPs. Unlike standard technique, we placed two-contact electrode for stimulation either in the area of the bottom of the fourth ventricle or on posterior surface of the spinal cord along the midline. This allows us to stimulate pontine tegmentum or posterior columns of spinal cord.

Results: We demonstrated the feasibility of this method in 2 cases.

Conclusion: The advantage of this method is possible brainstem or spinal cord stimulation reducing the chain of somatosensory tract that is valuable to neutralize the effect of anesthesia on significance of neurophysiological data.

Higher effectiveness of cerebrospinal fluid shunting procedures is still an unresolved issue in the treatment of idiopathic normal pressure hydrocephalus. Thus, over 15% of patients do not experience symptom regression in postoperative period. In recent years, several MRI predictors have been actively investigated to forecast the outcomes of cerebrospinal fluid shunting procedures. We have previously introduced a prognostic model for comprehensive evaluation of MRI data facilitating identification of patients likely to benefit from surgical intervention.

Objective: To evaluate diagnostic properties of MRI data comprehensive assessment model compared to traditional invasive diagnostic method (spinal tap test) in prospective randomized trial.

Material and methods: MRI data and postoperative outcomes in patients diagnosed with idiopathic normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between September 2022 and April 2024 were analyzed in prospective randomized study. In the study group, surgical decisions were based on MRI data, while the control group followed an algorithm incorporating invasive diagnostic method (spinal tap-test). Ventriculoperitoneal shunting with constant-pressure valve implantation was performed in all patients selected for surgery.

Results: The study included 54 patients (25 ones in the study group and 29 ones in the control group). Surgery was performed in 21 and 20 patients, respectively. We found no advantages of invasive diagnostic methods over comprehensive assessment of MRI data in predicting the effectiveness of surgical treatment.

Conclusion: Comprehensive assessment of MRI findings allows for avoiding invasive diagnostic procedures in decision-making on cerebrospinal fluid shunting surgery in some patients with idiopathic normal pressure hydrocephalus.

Background: Intramedullary spinal cord tumors are a rare group of central nervous system tumors with special treatment approaches. The main problems are related to optimal time of surgery, invasiveness and recurrence of tumor.

Objective: To review available literature data on the treatment of intramedullary spinal cord tumors, to summarize the main achievements and changes in treatment strategy over the past 5 years.

Material and methods: We reviewed Russian- and English-language literature on the treatment of intramedullary spinal cord tumors over the past five years. The studies were selected in accordance with PRISMA recommendations.

Results: We analyzed literature data in the PubMed, eLibrary, Cochrane and Medline databases over the last 5 years. The studies were selected taking into account the relevance and quality of researches.

Conclusion: Large-scale studies are rare due to rarity of intramedullary spinal cord tumors. The main changes in surgery for intramedullary spinal cord tumors in recent years have occurred due to changes in surgical tactics (emphasis on functional status rather total resection), improvement of equipment for adjustment of surgical approach (MRI, intraoperative monitoring, intraoperative ultrasound), more accurate and effective adjuvant therapy contributing to preoperative shrinkage of tumor and preservation of functionally important areas.

Trigeminal neuralgia is a well-known disease characterized by excruciating, paroxysmal, piercing pain in the face. It is often provoked by facial expressions or eating. Physicians have attempted to describe this severe pain for the past two thousand years. They described cephalgia, but their descriptions were vague and did not correspond to what we now call trigeminal neuralgia. The first more precise description of trigeminal neuralgia was presented in the 17th century. However, pathogenesis was unclear for a long time. Only in the early 20th century, Walter Dandy suggested vascular compression of trigeminal root as a possible cause of disease.

Background: The cause of trigeminal neuralgia (TN) is vascular compression of the trigeminal root. The last one is also found on intact side and in people without TN. Magnetic resonance imaging (MRI) reveals vascular compression, root deformity and atrophy, as well as localization of neurovascular conflict. To assess significance of MR signs of vascular compression, we compared appropriate data with intraoperative findings.

Material and methods: Preoperative MRI-based measurement of length (A), width (B) of trigeminal root and distance between brainstem and compression point (C) was performed in 105 patients with TN (51 women and 54 men) aged 56 (22-82) years.

Results: Compression by superior cerebellar artery was detected in 69 cases, anterior inferior cerebellar artery - 6, both arteries - 9, artery and veins - 17, vein alone - 4 cases. Unilateral vascular compression was present in all cases, on intact side - in 31.4% of patients. On the side of trigeminal neuralgia, vessels were localized 1.56 mm (0.3-6.5 mm) away from the brainstem. Compression points were localized at a distance of less than half of nerve root width in 32.4% of cases, 0.5 - 1 width - 59%, 1.5 widths - 2.9%, 1.8-3.5 widths - in 5.7% of cases. On the intact side, vessels were localized 3.48 mm away from the brainstem (0.8-8.7 mm).

Conclusion: On the side of trigeminal neuralgia, vessels are localized away from the brainstem at a distance corresponding to trigeminal root width, and distal compression is rare. TN predominantly accompanies proximal vascular compression, and long length of glial segment of trigeminal root may underlie TN in distal compression.

Neurovascular compression syndrome of the upper thoracic outlet is a collective term encompassing various entities: cervical ribs, structural variations of the first rib, costoclavicular syndrome, fibromuscular anomalies of anterior and middle scalene muscles, pectoralis minor syndrome and various pathologies of subclavian vessels. Their combination is based on the common substrate subject to compression (neurovascular bundle passing through narrow cervicoaxillary canal).

Objective: To analyze research of etiology, pathogenesis and treatment of neurovascular compression syndrome of the upper thoracic outlet.

Results: Cervical ribs were described by Galen. However, these ribs have been associated with symptoms of neurovascular compression only in the 18th century. In 1903, F. Bramwell identified the second possible cause of neurovascular compression (structural variations of the first rib). In 1912, T.W. Todd described narrowing of costoclavicular space. In 1920, A.A. Law described fibromuscular bands in costoclavicular space. In 1929, H.C. Naffziger and W.I. Grant pointed out the role of hypertrophy or spasm of anterior scalene muscle. In 1945, I.S. Wright described pectoralis minor muscle syndrome («hyperabduction»). The main treatment was scalenotomy. Less common option was rib or clavicle resection. Modern methods of pathogenetic treatment and less traumatic surgical approaches began to be developed only in the late 20th - early 21st centuries. All above-described entities were considered separately. The common term «thoracic outlet syndrome» does not accurately reflect the mechanism and structures subject to compression.

Conclusion: It seems appropriate to group all forms of thoracic outlet pathology causing neurovascular compression into a single unit (neurovascular compression syndrome of the upper thoracic outlet).