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

Laparoscopic approach is common in pelvic tumor surgery. Several small samples of patients after laparoscopic resection of presacral neurogenic tumors were described. Safety and advantages of this intervention are interesting.

Objective: To analyze clinical outcomes of laparoscopic resection of presacral neurogenic tumors.

Material and methods: Eleven patients including 2 children aged 11 and 17 years underwent laparoscopic tumor resection between 2021 and 2024. We estimated tumor size and localization, surgery time, blood loss, complications, postoperative hospital-stay, histological diagnosis and continued growth or recurrence in the follow-up period. The median follow-up was 19.2 (3-36) months.

Results: Tumor size ranged from 4 to 10 cm, mean surgery time - 153.6 min, blood loss - 356.4 ml. Postoperative complications developed in 7 patients, including acute urinary retention, neuropathic pain syndrome, hematomas and dynamic intestinal obstruction. Total resection was achieved in 8 (72.7%) patients, subtotal resection - 2 (18.2%), partial resection - 1 (9.1%) case. Tumors were predominantly neurogenic: 6 (54.5%) - sacral nerve schwannomas, 1 (9%) - NF1-related schwannomatosis, 1 (9%) - meningioma, 1 (9%) - ganglioneuroma, 1 (9%) - fibromyxoid sarcoma, 1 (9%) - solitary fibrous tumor. There were no recurrences, continued growth or recurrence of preoperative symptoms in the follow-up period.

Conclusion: Laparoscopic resection of presacral neurogenic tumors is an effective surgical technique with good visualization of surgical field and possible gross total resection.

Background: Combination of different intracranial tumors is an infrequent phenomenon. Combination of pituitary adenomas with craniopharyngiomas is extremely rare.

Objective: To present exceptionally rare combinations of pituitary adenomas and craniopharyngiomas.

Results: We present two patients with combinations of pituitary adenomas and adamantinomatous craniopharyngiomas. Due to topographic and anatomical features of neoplasms, combined access was used for resection of both tumors in the first case (transcallosal and transnasal in different surgeries). The second patient required simultaneous endoscopic transnasal resection of both tumors. Baseline symptoms (decreased vision in both cases and mental disorders in the first case) partially regressed, and patients were discharged.

One of the complications of arachnoid cysts of the Sylvian fissure is subdural accumulations including hygromas or hematomas. The last ones follow spontaneous or traumatic cyst rupture. Subdural accumulations can occur after surgical treatment (cystocisternostomy).

Objective: To describe subdural accumulations in 2 children with arachnoid cysts of the Sylvian fissure; to review literature data on genesis of this phenomenon, prevention and treatment.

Material and methods: Two children with arachnoid cysts of the Sylvian fissure and subdural accumulations are presented. In the first case, subdural accumulations arose as a result of primary spontaneous cyst rupture, in the second case - after endoscopic cystocisternostomy.

Results: The first child had spontaneous arachnoid cyst rupture Galassi type 2 with subsequent chronic subdural left-sided hematoma in the frontal-temporal-parietal region. Symptoms regressed after microsurgical subdural cystocisternostomy. Follow-up MRI after discharge revealed no subdural accumulations and brain dislocation. The second child had arachnoid cyst of the left Sylvian fissure Galassi type 3. After endoscopic cystocisternostomy, MRI in the first year revealed clinically insignificant subdural accumulations recognized as chronic subdural hygroma, after another year - as chronic hematoma. MRI after 3 years demonstrated complete regression of subdural accumulations.

Conclusion: Microsurgery with creation of communication between subdural cavity, cyst and basal cisterns is preferable for spontaneous rupture of arachnoid cysts of the Sylvian fissure and tense subdural accumulations in children. Isolated drainage of subdural accumulations may be sufficient in some cases. Clinically not significant subdural CSF collections after endoscopic fenestration of Sylvian fissure arachnoid cysts in children are often and do not require surgical correction in the majority of cases.

Background: Surgical treatment of large epidermoid cysts located of the cerebellopontine angle (CPA) with supra- and infratentorial extension poses significant challenges due to complex anatomy and potential neurovascular involvement. Standard approaches may require extensive bone resection with considerable risks.

Objective: To evaluate the efficacy and safety of a combined retrosigmoid and subtemporal burr-hole microsurgical approach for epidermoid cysts with infra- and supratentorial extension.

Material and methods: Four patients with large epidermoid cysts involving multiple anatomical compartments (CPA, prepontine, interpeduncular, and supratentorial regions) underwent surgery between 2017 and 2024. A combined retrosigmoid and subtemporal burr-hole microsurgical approach was performed without extensive bone resection, tentorial incision or petrous bone involvement.

Results: Subtotal (>95%) resection was achieved in three patients. There was dense adhesion of cyst capsule to critical neurovascular structures. Total resection was feasible in one patient. Transient postoperative deficit involved cranial nerves III, VI, VII, IX and X. Permanent sensorineural hearing loss occurred in two patients. No cerebrospinal fluid leakage or infectious complications were observed. Patients experienced rapid postoperative recovery.

Conclusion: A combined retrosigmoid and subtemporal burr-hole approach offers an effective and safe alternative to traditional skull base approaches for extensive epidermoid cysts minimizing surgical trauma and reducing postoperative morbidity.

Background: Arachnoid cysts are predominantly congenital pathologies associated with cleft of arachnoid membrane of spinal cord or brain. Arachnoid cysts present with cerebral, hypertensive-hydrocephalic and focal symptoms. Localization of intracranial arachnoid cysts can vary. Only 12% of symptomatic arachnoid cysts are localized in posterior cranial fossa.

Objective: To present successful treatment of a patient with retrosellar arachnoid cyst, review available literature data and compare clinical course and treatment outcomes.

Material and methods: A 29-year-old female patient presented with long-term history of headache, dizziness, diplopia and statodynamic disturbances. Magnetic resonance imaging revealed giant retrosellar arachnoid cyst compressing the brainstem and causing hydrocephalus. The PubMed database was screened (2015-2025). Only full-text articles In Russian and English were included. References of these articles comprised secondary searching.

Results and discussion: Endoscopic cystoventriculocisternostomy of arachnoid cyst in posterior fossa was performed. Postoperative period was uneventful. Neurological and ophthalmological status was the same. MRI revealed significant improvement including cyst shrinkage and regression of symptoms over a 3-month period. There were only 7 relevant reports.

Conclusion: Correct surgical approach is confirmed by cyst shrinkage after surgery and clinical follow-up data.

Positive effect of resection quality on recurrence-free and overall survival in patients with glioblastoma has been shown in several studies. Fluorescence navigation is one of the methods increasing extent of resection. However, possible causes of incomplete resection may be misinterpretation of fading fluorescence or missed fluorescent tumor tissue due to lack of direct visibility between tumor tissue and microscope.

Objective: To evaluate the effect of fluorescence navigation and endoscopic assistance on resection quality and outcomes; to analyze whether endoscope in fluorescence mode can overcome some limitations of resection following surgery under fluorescence-guided microscope.

Material and methods: The study included 10 patients who underwent glioblastoma resection under fluorescence microscopic and endoscopic control. In 5 patients, 5 ALA (Alasens) at a dose of 20 mg/kg was used as a fluorescence inducer, in 5 patients - chlorin e6 (Photoditazine) at a dose of 1 mg/kg. Initially, microsurgical resection of all fluorescent tissue was performed using a microscope. Then, resection cavity was scanned with endoscope. Fluorescent tissue not visualized by microscope was additionally removed with subsequent morphological analysis.

Results: Endoscope fluorescence detection thresholds were lower than microscope thresholds at working distances of 30 and 10 mm. In all patients, additional fluorescent tissue was detected after endoscopy. This tissue was completely resected in all cases. Histological examination confirmed tumor tissue in additionally resected areas. Total resection was achieved in all cases as evidenced by postoperative contrast-enhanced MRI.

Conclusion: Endoscopic resection of glioblastomas with fluorescence navigation significantly increases the rate of total resection. It is a useful adjunct to microscopic resection under fluorescence control.

Background: Surgical treatment is possible for drug-resistant epilepsy. Localization of epileptogenic zone in temporal lobe or outside it influences the effectiveness of surgical treatment.

Objective: To evaluate the effectiveness of surgical treatment of drug-resistant epilepsy.

Material and methods: Postoperative outcomes were analyzed in patients with drug-resistant epilepsy between 2016 and 2022.

Results: There were 346 resections and 66 palliative surgeries. Effectiveness of resections (Engel I outcome) was 79% for temporal epilepsy and 62% for extratemporal epilepsy.

Conclusion: Our data on effectiveness of surgical treatment are consistent with data of other studies.

The authors studied motor disorders in idiopathic normotensive hydrocephalus (iNPH, Hakim-Adams syndrome) using C-Mill treadmill.

Objective: To present the first experience of C-Mill in assessing the motor function in patients with iNPH.

Material and methods: The study is carried out at the Pavlov State Medical University and Hospital for War Veterans. To date, we enrolled 10 patients with iNPH and examined these ones using a unique multifunctional tool C-Mill before surgery, after tap test and after cerebrospinal fluid bypass surgery.

Results: In all cases, we obtained positive postoperative results with improvement of motor function.

Conclusion: C-Mill is a special treadmill with built-in tools designed to analyze human gait and balance, as well as for rehabilitation to improve gait and balance disorders in virtual reality. C-Mill sensory treadmill is valuable to assess motor disorders in patients with iNPH before surgery, improve the diagnostic process when selecting patients for surgery using invasive diagnostic methods and significantly improve the accuracy of postoperative evaluating the effectiveness of surgical treatment by quantifying the regression of motor disorders.

Background: One of the elements of lower back pain is facet syndrome. Radiofrequency facet denervation is an effective minimally invasive method for this pain. There is no consensus regarding local anesthesia method for this manipulation. Researchers believe that introduction of anesthetic before denervation leads to needle displacement and deterioration of effect.

Objective: To evaluate the influence of local anesthesia methods on the results of radiofrequency facet denervation.

Material and methods: A single-center retrospective study included adults with typical pain syndrome who underwent radiofrequency facet denervation L3-S1 between 2022 and 2024. Patients were divided into three groups depending on anesthesia. In the control group («K»), patients did not receive injection of anesthetic in ablation area. In the main groups, patients received injection of anesthetic before (group «A») and after (group «B») denervation. Intensity of pain syndrome during denervation and 24 hours later was assessed using the VAS scale. After 6 months, effectiveness of the procedure was assessed using the SF-36 and ODI.

Results and discussion: The study involved 351 people. Of these, 131 ones were excluded for various reasons. Patients were divided into groups: control - 67, group «A» - 87, group «B» - 66 people. Six months after denervation, all patients demonstrate significant reduction in pain syndrome and QoL improvement without significant between-group differences. Pain syndrome during denervation and on the first day after surgery was significantly lower in the group «A».

Conclusion: Injection of anesthetic before denervation does not affect the result, while this approach significantly reduces pain syndrome during intervention.

Full-endoscopic (neuroendoscopic) removal of foreign bodies from the cranial cavity is a relatively new technique with limited information available in the literature. Compared to open surgeries, this minimally invasive approach is associated with less impact on the surrounding brain tissues and fewer complications. The safety of such procedures is enhanced by the use of CT navigation. This article describes the surgical technique of endoscopic removal of metallic fragments in combat-related gunshot cranial injuries, based on five clinical cases, and presents the results of a systematic literature review.

Objective: To evaluate the capabilities and effectiveness of fully endoscopic surgery in combat-related gunshot cranial injuries and to compare the obtained results with the data available in the global literature.

Material and methods: In the neurosurgery clinic of the Military Medical Academy named after S.M. Kirov, from March 2023 to June 2024, 5 patients with shrapnel wounds to the head underwent removal of foreign bodies using endoscopic techniques. The databases of scientific publications PubMed, Google Scholar, and eLibrary searched for publications in accordance with the rules of systematic review, and 12 articles were found that fully meet the search criteria.

Results: All 5 patients were successfully operated using endoscopic techniques. Endoscopic rehabilitation of a gunshot wound is an optional minimally invasive neurosurgical procedure and can be effectively applied in a specialized hospital to remove foreign bodies localized deep in the brain, ventricles, and base of the skull, with a high risk of their removal during primary surgical treatment or its non-radical implementation.