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

Treatment of motor disorders by MRI-guided focused ultrasound is an alternative to neuro- and radiosurgery such as stereotactic radiofrequency ablation and thalamotomy with a gamma knife. However, safety, efficacy and feasibility of this technology for intracranial neoplasms are still unclear. The authors report successful hypothalamic hamartoma dissection by MRI-guided focused ultrasound in a 32-year-old woman with drug-resistant gelastic epilepsy and violent laughter and crying attacks. Magnetic resonance imaging revealed type II hypothalamic hamartoma. The last one was detached from surrounding brain tissue by MRI-guided focused ultrasound without side effects. Symptoms regressed immediately after surgery. No laughter and crying attacks were observed throughout 6-month follow-up.

The manuscript is devoted to development of information support system for a bioresource collection - biological information system «NeuroOnc». Architecture and main functions of system are presented. This system was formed in the project «Development of bioresource collection of tumors of the human nervous system with molecular genetic certification for personalized treatment of patients with neuro-oncological diseases». The purpose of this project was not only formation of bioresource collection, but also development of various molecular genetic methods for analysis of biospecimens in context of clinical researches. Biological information systems created to support the work of bioresource collections in hospitals should become a natural part of information infrastructure. Information support of bioresource collections cannot imply only «warehouse» functions. This system should have tools to support various scientific and clinical researches. Biological information systems can sometimes expand medical information systems but remain sufficiently autonomous. It is advisable to develop biological information systems in large specialized companies that can support their products for many years.

The main stages of endoscopic skull base repair in patients with cerebrospinal fluid (CSF) leakage are identification of bone boundaries of the fistula and its closure by auto- and allografts. Fibrin glue can be used to fix plastic materials and additionally seal skull base defect.

Objective: To analyze efficacy and safety of Vivostat autologous fibrin glue for endoscopic skull base repair in patients with nasal CSF leakage and to compare postoperative outcomes after defect closure by Vivostat fibrin glue and allogeneic fibrin glue.

Material and methods: A retro- and prospective analysis included 56 patients with nasal CSF leakage who were treated at the Burdenko Neurosurgery Center between January 2021 and June 2022. Patients were divided into 2 groups: Vivostat fibrin glue (n=27, 48.2%) and allogeneic fibrin glue (n=29, 51.8%). Demographic and clinical perioperative data were analyzed.

Results: No early postoperative recurrence of CSF leakage was registered in both groups, whereas meningitis occurred in 2 cases in each group. Recurrent CSF leakage in delayed postoperative period occurred in 1 patient (3.4%) of the control group (p>0.05). Incidence of perioperative complications, subfebrile temperature in early postoperative period, surgery time and hospital-stay were similar.

Conclusion: Vivostat autologous fibrin glue is a safe and effective method for fixing the grafts in endoscopic skull base repair. The advantages of this approach are easy application, elimination of the risk of allergic, immunological and infectious complications, as well as acceleration of tissue regeneration.

Posterior longitudinal ligament ossification is a progressive disease resulting in severe multilevel spinal stenosis with myelopathy. Decompression via anterior or posterior approach is the main treatment option. Decompressive laminoplasty is currently considered the most effective and safest method. This procedure provides favorable outcomes with low trauma and short surgery time. Redo surgeries are rare and most often performed within 2 years after primary laminoplasty. The most common causes are progressive spinal stenosis following posterior longitudinal ligament ossification, insufficient primary decompression and progressive cervical spine kyphosis. Considering few data on redo laminoplasty, we present a patient with progressive ossification of posterior longitudinal ligament who underwent redo surgery at the same level in 10 years after primary laminoplasty.

The purpose of the study was to improve classification of neurogenic (neuropathic) pain syndromes. This will make it possible to define the indications for appropriate analgesic surgery for each type of drug-resistant neurogenic pain syndrome. Incorrect management of neurogenic pain syndromes is usually associated with underestimation of pathogenetic prerequisites for its occurrence. Differentiation of compression, deafferentation and mixed neurogenic pain syndromes makes it possible to determine appropriate surgery and avoid tactical errors. Moreover, this approach allows you to save patients from unreasonable long-standing suffering. Patients with chronic pain syndromes often become disabled, sometimes in the prime of life, and isolated from society and family. Therefore, treatment of chronic pain is currently an urgent problem.

The authors present an extremely rare case of metastatic brain lesion in a patient with gastrointestinal stromal tumor of the stomach. There are literature data on 23 cases of metastatic lesions of the brain, skull and soft tissues of the head in similar patients. Atypical localization of metastases can lead to some diagnostic difficulties, unreasonable cancellation of chemotherapy and delayed surgical treatment. A feature of our observation was postoperative coma determined by the features of the underlying disease.

Surgical removal of cranio-orbital meningiomas is an effective method of treating this pathology. Modern surgical techniques and technologies make it possible to perform operations with a low risk of complications. Lumbar drainage or repeated lumbar punctures are often used intraoperatively or in the early postoperative period to prevent nasal CSF leak; this rarely leads to the development of significant neurological symptoms. We present a case of the development of severe intracranial hypotension with the formation of a subdural hygroma in the early postoperative period after removal of a cranio-orbital meningioma in a 41-year-old patient. The operation was performed using an individual model and molds for simultaneous reconstruction of the bone defect with an implant made of polymethyl methacrylate. On the 1st and 2nd days after surgery, lumbar punctures were performed. From the 2nd day there was a progressive deterioration with the development of symptoms characteristic of intracranial hypotension. Computed tomography revealed an increasing displacement of the midline structures of the brain and an increasing volume of epidural fluid accumulation in the area of surgical intervention. Magnetic resonance imaging revealed characteristic signs of intracranial hypotension. Conservative treatment (bed rest, active hydration) had no effect. On the 6th day after surgery, an epidural blood patch procedure was performed and closed external drainage of the epidural hygroma was performed, and a rapid regression of neurological symptoms was noted. Our experience and literature data indicate that it is necessary to remember the possibility of developing clinically significant intracranial hypotension even after a single lumbar puncture. The formation of hygromas in the surgical area is characteristic of intracranial hypotension, but in most cases does not require additional surgical intervention and does not have a negative impact on the outcome of treatment. Conservative treatment of intracranial hypotension is the first choice and often sufficient. If there is no effect and the patient's condition worsens, it is necessary to perform an epidural blood patch procedure.

Background: Pathogenesis of peritumoral cerebral edema is unclear and potentially associated with glymphatic system dysfunction. Diffusion tensor MRI (DT-MRI) with analysis of ALPS (Analysis along the Perivascular Space) index may be valuable for assessment of edema. This approach visualizes fluid flow along perivascular spaces of deep cerebral veins.

Objective: To assess glymphatic system function in supratentorial tumors and healthy volunteers using DT-MRI.

Material and methods: There were 52 patients (59% men) aged 43 (28-64) years with supratentorial tumors (meningioma - 20, grade 3-4 glioma - 15, metastases - 9, lymphoma - 8). Tumors and perifocal edema did not involve deep cerebral veins. The control group included 6 healthy volunteers aged 34-66 years. MRI protocol (Signa HDxt, 3 T) contained standard T1, T2, T2FLAIR, DWI and post-contrast T1 (3D BRAVO). DT-MRI had the following parameters: TR=10 000 ms, TE_min=102 ms, FOV=240 mm, isotropic voxel size 3×3×3 mm³, 60 directions of diffusion gradients. Measurements were carried out at b-factor 0 and 1000 s/mm². Analysis was carried out in the ReadyView software.

Results: Right- and left-sided ALPS indices were similar in the control group (p=0.917). Perifocal edema (regardless of histological type of tumor) in the ipsilateral hemisphere was accompanied by significantly lower ALPS index (p<0.005), while these values in contralateral (intact) hemisphere were similar in both groups (p=0.7).

Conclusion: We found significantly lower ALPS index in deep parts of the affected hemisphere in patients with perifocal edema. These data can indicate the role of glymphatic system dysfunction in pathogenesis of this pathology.

Background: Chordoid glioma is a rare slow-growing tumor of the central nervous system. Available world experience includes no more than 200 cases (lesion of the third ventricle in absolute majority of cases). Recognition and treatment of chordoid glioma are currently difficult problems due to small incidence of this disease.

Objective: To describe clinical manifestations and surgical treatment of chordoid glioma of the third ventricle considering literature data and own experience.

Material and methods: There were 12 patients (6 men and 6 women) with chordoid glioma between 2004 and 2023 (10 patients with lesion of the third ventricle, 1 - lateral ventricle, 1 - pineal region). Only patients with tumors of the third ventricle were analyzed.

Results: Total and subtotal resection was performed in 1 and 3 cases, respectively. Five patients underwent partial resection, 1 patient underwent biopsy. The follow-up data were available in 7 out of 10 patients (mean 25 months). Radiotherapy was performed in 4 patients (continued tumor growth in 2 cases). One patient died.

Conclusion: Chordoid glioma is a benign tumor predominantly localized in the third ventricle. Preoperative MRI and CT in some cases make it possible to suspect chordoid glioma and differentiate this tumor from craniopharyngioma, meningioma and pituitary adenoma by such signs as isointense signal in T1WI, hyper- or isointense signal in T2WI, homogeneous contrast enhancement and edema of basal ganglia in T2 FLAIR images. The only effective treatment for chordoid glioma is surgery. Total resection is often impossible or extremely dangerous due to location of tumor, large size and invasion of the third ventricle. Postoperative mental disorders and diabetes insipidus, including severe hypernatremia, are common that requires mandatory monitoring of water and electrolyte balance.

Background: Effectiveness of surgical revascularization in patients with chronic cerebral ischemia depends on restoration of circulation in the damaged artery. Modern methods do not take into account dynamic changes in cerebral perfusion after extra-intracranial microvascular anastomosis (EICMA) and do not allow timely localizing the areas of persistent perfusion deficit. We propose a new method for determining the tactics of surgical cerebral revascularization based on intraoperative MRI (iMRI) perfusion data. This method provides the earliest information on intraoperative brain reperfusion.

Objective: To develop the principles of dynamic assessment of cerebral blood flow using intraoperative ASL perfusion during surgical revascularization in patients with chronic cerebral ischemia and to determine the indications for additional anastomoses.

Material and methods: Surgical revascularization with intraoperative MRI perfusion was performed in 27 patients between March 2022 and April 2023. There were 10 patients with post-thrombotic occlusion of internal carotid artery, 4 patients with occlusion of middle cerebral artery and 13 patients with moyamoya disease. All patients underwent MRI before surgery. After imposing the first EICMA, all patients underwent ASL perfusion for analysis of residual hypoperfusion zones, signs of local hyperperfusion and indications or contraindications for additional revascularization with the second donor branch.

Results: In all cases, iMRI made it possible to determine the tactics of brain revascularization using one or two EICMA. In 17 cases, ASL perfusion confirmed the targeted improvement of cerebral blood flow (CBF) in the entire hemisphere or middle cerebral artery basin. Only one EICMA was imposed in these cases. In 10 cases, a single anastomosis was insufficient for restoration of blood flow. These patients underwent additional revascularization with the second donor branch (35.7%). In all cases, we achieved significant quantitative improvement in CBF and volume of brain tissue with restored blood flow (ASPECTS scale). A single EICMA was followed by increase in CBF and areas of restored blood flow by almost 2 times (22.7±9.6 ml/100 g/min and 4.7±1.8 scores (ASPECTS) before surgery vs. 39.4±16.4 ml/100 g/min and 4.7±1.8 scores after EICMA). In the double EICMA group, these parameters increased by almost 3 times (18±3.1 ml/100 g/min and 3.8±0.9 scores before surgery vs. 57±11.4 ml/100 g/min and 7.7±1.5 scores after double EICMA). All patients had no complications. Neurological status improved immediately after surgery in 9 patients (33.3%), stable postoperative period was observed in 12 cases (44.4%). Six (22.2%) patients had transient neurological deficit associated with hyperperfusion syndrome that regressed within a few days after surgery. There were no persistent ischemic complications.

Conclusion: In