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

The combination of basal encephalocele with craniosynostosis is a rare clinical situation. Few observations of these two pathologies combination are described in the literature. Objective: to analyze own sample of patients to determine possible causes of encephalocele formation and surgical treatment strategy.

Material and methods: Medical records of 4 patients with combination of encephalocele and craniosynostosis were analyzed. Data on complaints, medical history, results of medical specialists' examinations were studied. Data of CT and MRI, craniometric analysis were assessed. Obtained results were compared with literature data.

Results: Encephalocele development in patients with craniosynostosis was secondary and related to various causes such as traumas, iatrogenic injury, intracranial hypertension. The most significant factor in occurrence and development of nasal liquorrhea relapse is increased cerebrospinal fluid pressure.

Conclusion: The treatment strategy for patients with basal encephalocele can be determined by the presence of intracranial hypertension and its increase after nasal liquorrhea elimination. One of the possible signs of long-lasting intracranial hypertension in children is a symptom of increased convolutional markings pattern according to the CT. If this sign is detected, it is justified to perform transcranial plastic surgery of cerebrospinal fluid-venous fistula with simultaneous reconstruction of the skull bones.

Malignant transformation of fibrous dysplasia in McCune-Albright syndrome is observed in less than 1% of cases, thus osteosarcoma is developing more frequently. According to the search in the PubMed database over the last 5 years, 13 publications were found, but none of them described cerebral cranium damage.

Material and methods: A clinical observation of a 27-year-old patient with polyostotic fibrous dysplasia, skin manifestations and prolactin+HGH-secreting pituitary adenoma - McCune-Albright syndrome - without GNAS gene mutation is described. The patient had a rapidly increasing formation in the left temporoparietal region, which reached 18×20×15 cm, accompanied by local pain and fever 4 months prior to hospitalization. Diagnosis of osteosarcoma was verified by biopsy. Neoadjuvant chemotherapy in the presence of intracranial hypertension and giant tumor has been refused.

Results: Preoperative embolization of tumor vessels with polyvinyl alcohol emboli was moderately effective. Tumor node has been removed, blood loss amounted to 5500 ml, blood autodonation, cell saver, 1 dose of donor erythrocytes were used. On the 1st day, the patient was transferred to the clinical unit, pain and fever ceased. He was discharged on the 8th day in satisfactory condition. Nevertheless, chemotherapy in the home area was not performed and the patient died from the disease progression in 1.5 months. The algorithm of care in osteosarcoma - neoadjuvant chemotherapy, tumor resection and adjuvant treatment.

However, the results of such treatment remain generally unsatisfactory. The algorithm of treatment for patients with fibrous dysplasia malignancy in McCune-Albright syndrome is not presented in the literature. The surgical intervention resulted in the removal of the main tumor volume and regression of intracranial hypertension, but did not significantly affect the patient's fate in the absence of adjuvant chemotherapy.

Conclusion: The possibility of malignant neoplasms development from fibrous dysplasia in McCune-Albright syndrome must be taken into consideration. The development of an algorithm for care in such patients requires accumulation of material and its analysis.

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.

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.

Gliomas are among the most aggressive primary brain tumors characterized by extremely poor prognosis. Despite standard therapy including surgery, radiotherapy and chemotherapy, median survival remains extremely low. The main obstacles to effective treatment are tumor heterogeneity, blood-brain barrier and difficult targeted delivery of therapeutic agents. This review examines potential of aptamers as an alternative to traditional approaches. A particular attention is paid to mechanisms of aptamer cross-breeding and cellular internalization, particularly receptor-mediated endocytosis. The last one is essential for efficient penetration of these molecules into tumor cells. Analysis of current data demonstrates that aptamers specific to glioma cell surface markers not only provide highly accurate tumor imaging but also open new opportunities for target delivery of therapeutic agents. It is a promising tool for personalized glioblastoma therapy.

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).

Background: There are some unresolved issues in surgery for gliomas of Broca's area (optimal intraoperative testing, cortical mapping, and stimulation parameters).

Objective: To clarify the peculiarities of neurosurgical technique and speech testing in surgery for gliomas of Broca's area.

Material and methods: A single-center cohort retrospective study was devoted to surgical treatment of patients with Broca's area gliomas in 2014-2023. Speech function was evaluated preoperatively, 7 days and 6 months after surgery. The Russian intraoperative naming test was used to assess speech production and understanding. Speech disorders were categorized as normal (2.1 to 3 points), moderate (1.1 to 2 points), and severe (0 to 1 point). Final analysis included 47 patients.

Results: Total resection was performed in 27 (58%) patients, near-total - 7 (15%), subtotal - 4 (8%), partial - in 9 (19%) cases. Mean resection rate was 92%. At baseline, there were 9 (19%) patients with aphasia (severe - 2 (4%), moderate - 7 (15%) patients). In 7 days after surgery, 31 (66%) ones had speech disorders (severe - 12 (24%), moderate - 19 (40%) cases). In 6 months after surgery, aphasia persisted in 10 (21%) patients (severe - 3 (6%), moderate - 7 (15%) cases).

Conclusion: Broca's area gliomas do not require craniotomy larger than tumor projection size and «positive» mapping of all visible cortical areas, except for those regions where encephalotomy is planned («negative» mapping). When assessing the risks of persistent speech disorders, one should take into account such factors as tumor malignancy grade, baseline speech disorders, the need for mapping of motor areas, spread of tumor from Broca's area to parietal lobe and subcortical nuclei. For more accurate determination of cortical speech zones in Broca's area, testing should include naming of actions.

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.