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

In everyday clinical practice, neurosurgeons usually deal with glial tumors localized precisely in the frontal lobe. There is a widespread opinion that almost any neurosurgeon can resect glioma of the frontal lobe regardless of experience and microsurgical skills. However, working at the federal center, we observe how employees often have to operate on patients with frontal lobe gliomas after previous surgery in other hospitals. Therefore, treatment of these patients seems to be quite difficult problem of neurosurgery for glial tumors, and incidence of postoperative complications is still high. We analyzed literature data on anatomical and functional aspects of surgery for frontal lobe gliomas and practical nuances of their surgical treatment. Motor functional system of the frontal lobe is represented by several cortical zones united into a complexly organized network of functional connections through associative fibers. Theor lesion can lead to postoperative motor deficit.

All perioperative invasive procedures, including those associated with autologous blood circulation in extracorporeal circuit, should be considered as a risk factor of infectious complications. Despite perioperative antibiotic prophylaxis and compliance with standards for hardware reinfusion in neurosurgical interventions, bacterial contamination of autologous blood occurs in 38.3% of cases. One of the risk factors may be surgical approach.

Objective: To analyze the influence of surgical access on bacterial contamination of autologous blood and effectiveness of complex decontamination in hardware reinfusion in neurosurgery.

Material and methods: The study included 107 patients with CNS tumors and high risk of intraoperative blood loss with hardware blood reinfusion. Three surgical approaches were used: transcranial, extended transcranial with opening of paranasal sinuses and transnasal endoscopic access. The protocol of perioperative antibiotic prophylaxis was used in all patients. We evaluated bacterial contamination after decontamination using microbiological testing.

Results: Surgical approach significantly affected the risk of bacterial contamination of autologous blood in neurosurgical patients (p<0.001). The minimum risk was observed for transcranial approaches (29%), moderate - for extended transcranial approaches (50%), maximum - for transnasal endoscopic approaches (100%). This pattern is not presented in available literature. There were no local or systemic infectious complications in postoperative period.

Conclusion: Transfusion of autologous blood is quite safe in case of appropriate perioperative antibiotic prophylaxis and all measures aimed at blood decontamination. Approaches with opening the paranasal sinuses require 4-stage decontamination (cefuroxime+washing+leukofiltration+irradiation).

Background. s: Uccessful endoscopic third ventriculostomy (ETV) depends on patient characteristics, including age, etiology of hydrocephalus and previous shunting. Kulkarni et al. [1] developed the Endoscopic Third Ventriculostomy Success Score (ETVSS) to predict the success of ETV using these factors. We analyzed own experience of ETV in children under one year of age and validity of the ETVSS scale.

Objective: To assess prognostic significance of the ETVSS scale in children under one year of age after ETV.

Material and methods: There were 1105 surgeries in children with hydrocephalus between 2012 and 2021 including 273 ETV procedures. Primary ETV was performed in 129 patients (47.3% of all procedures), they met the inclusion criteria. ETVSS score was calculated retrospectively for each patient and compared with actual success of ETV. ROC analysis was used to determine the quality of the validated version of the ETVSS scale.

Results: The study included 129 primary ETVs in children under one year of age. Success rate was 52.7% (n=68), the minimum follow-up - 6 months. When analyzing the results, we found mild prognostic underestimation in short-term and long-term outcomes of ETV according to the ETVSS scale. ROC analysis revealed AUC 0.67 that corresponds to satisfactory level of this classification. Sensitivity was 66%, specificity - 63%.

Conclusion: ETVSS scale demonstrated good ability to predict success according to actual success rate of ETV in neonates and infants. This tool may be useful in decision-making for endoscopic surgery. The ETVSS scale should be used by neurosurgeons to assess possible outcomes after ETV in infants.

Introduction: The concept of «complex» aneurysm is now widely used in the planning of neurosurgical interventions. It is obvious that the definition and objectification of this concept should be separate for microsurgical and endovascular treatment.

Objective: Is to objectify the «complex aneurysm» concept with regard to endovascular treatment.

Material and methods: A total of 739 patients, who underwent endovascular treatment of the unruptured aneurysm in the NMRC of Neurosurgery named after Academician N. N Burdenko in the period from 01.01.2018 to 01.02.2022, were analyzed. We evaluated 8 anatomical and morphological characteristics (AMCs) of the aneurysm and presence of 2 pathologies of brachiocephalic arteries (BCAs). Statistical analysis of the treatment results, determination of the statistical significance of differences in complications incidence depending on the presence of studied AMCs of the aneurysm and BCAs pathology were performed. On the basis of this analysis, an index of the complexity of endovascular treatment of unruptured aneurysms (ICAe) was created and the significance of differences in the incidence of complications according to the value of ICAe was evaluated. Web application for ICAe calculation - www.isae.rf - was created.

Results: The proportion of patients with pronounced neurological deficit on the day of discharge amounted to 0.8%, the incidence of death - 0.1% (1 patient). New neurological deficit after the surgery occurred in 4.6% of cases, moderate and severe complications - in 3.2% of cases. Non-radical aneurysm exclusion after 12 months was observed in 22.1% of cases.

At ICAe=0, the incidence of complications was lower in the general group by 0.9 - 10.9%. The ICAe value of 1 score was intermediate (part of complications occurred more often, part less). The incidence of adverse outcomes and complications was increased by 1.8-18.5% for ICAe=2, by 0.8-27.9% for ICAe=3 and by 6.5-28.7% for ICAe=4-5.

Conclusion: The created ICAe allows to objectively distinguish a group of aneurysms complex for endovascular treatment, stratify aneurysm complexity and incidence of adverse outcomes and complications.

Aneurysms with ICAe³2 can be classified as «complex» for endovascular treatment.

Surgical treatment of cancer patients with severe neurological symptoms is a complex multidisciplinary problem that often does not lead to a positive disease's outcome. It is also not always possible to perform operative treatment in a short time frame after paraparesis debut.

Objective: To evaluate the impact of the timeframe from the onset of neurological disorders to surgical decompression in patients with plegia, caused by the neural structures compression by the spinal tumor, on the disease's outcome.

Material and methods: An observation of 34 patients who underwent surgery for epidural tumor compression of the spinal neural structures from 2005 to 2021 was presented. Functional deficit was evaluated by the Karnofsky, ASIA AIS scales. All patients had paraplegia and sensitivity impairment (ASIA AIS A, B) before the operation. Primary sources were the mammary gland (7.7%), prostate (15%), kidney (27%), multiple myeloma (3.8%), lungs, liver and plasmocytoma (by 7.7% each), stomach, colon and chondrosarcoma (3.8%), other tumors (15.8%).

Results: Surgical treatment demonstrates a satisfactory result in the form of partial or complete restoration of the neurological deficit in a quarter of cases (23.5%) with no significant impact on life expectancy. Each day of persistent compression of the neural structures reduces the probability of neurological deficit regression by 4%.

Conclusion: Performance of surgery in patients with severe neurological disorders 27 days or more after the debut has an extremely low probability of restoring the ability to move independently. Diagnostic awareness in the detection of spinal tumors and timely surgical treatment of patients with the threat of developing epidural compression of the neural structures allow to reduce the risk of disability and improve the quality of life of patients.

Background: Metastatic brain lesions following Ewing sarcoma of bones and soft tissues in children are extremely rare and have unfavorable prognosis. There are few publications devoted to this issue. Survival rates after craniotomy are extremely low.

The authors describe a patient with metastatic form of Ewing sarcoma and two intracerebral (supra- and infratentorial) metastases. Total resection with subsequent radio- and chemotherapy were followed by stable remission for 23 months.

Background: High-risk cerebral AVMs (Spetzler-Martin grade IV-V) are characterized by higher cumulative risk of hemorrhage during life, as well as higher mortality and disability rates in case of rupture compared to low-risk AVMs. Nevertheless, there are currently no clear indications for surgical intervention for high-risk AVMs, and most patients with this disease are followed-up. However, available data on less favorable course of high-risk AVMs requires active surgical tactics to reduce long-term disability and mortality.

Currently, the following strategies are preferable for high-risk AVMs: combination of preoperative embolization with microsurgical resection and combination of partial endovascular embolization with subsequent radiosurgery.

Objective: To analyze the most common treatment combinations for high-risk AVMs regarding resection quality, functional outcomes and complications.

Material and methods: The study was carried out in accordance with international recommendations for systematic reviews and meta-analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Searching was conducted in the Pubmed/Medline and eLibrary databases using the keywords «High grade», «Arteriovenous Malformations», «Management», «IV-V» and «AVM» for English-language search engines, "high-grade arteriovenous malformations." for Russian-language systems. Available full-text English- and Russian-language articles were selected between 1981 and 2024.

Results: Among 371 articles, 6 studies met the inclusion criteria. There were 478 patients who underwent two most common strategies for combined treatment of high-risk AVMs.

Conclusion: At present, there is no consensus on the advantage of certain combined method. There are data on less favorable course of high-grade AVMs and unsatisfactory outcomes after monomodal treatment. Thus, combined methods may be valuable for such AVMs.

Unlike widespread and well-studied atherosclerosis of supra-aortic arteries, non-atherosclerotic vascular diseases are less common. Of these, one of the most unusual is extravasal compression by additional structures between scalene muscles. Close topographic and anatomical connections of scalene muscles, vertebral and subclavian arteries, brachial plexus and stellate ganglion can lead to complex syndrome including impaired blood supply to the arm, brachial plexus compression and vertebrobasilar circulatory disorders. The main treatment method for supraclavicular compression syndromes is surgery. However, differential diagnosis, indications for surgical treatment and optimal technique are still discussable due to small incidence of disease. The key factor in determining treatment strategy is the cause of compression (congenital or acquired scalene muscle hypertrophy, age-related ptosis of the shoulder girdle; neck injuries; cervical spine degeneration). One of the rarest causes of compression is rudimentary additional cervical rib («cervical rib syndrome») and vessels. Combination of these factors is a casuistic etiology. The authors present a 25-year-old patient with stellate ganglion schwannoma whose mass effect caused dislocation and compression of subclavian artery by rudimentary additional cervical rib and scalene muscle. Surgical treatment including resection of tumor, release of the artery and scalenotomy restored arterial patency and eliminated clinical symptoms.

Background: Surgical treatment of skull base and craniovertebral junction chordomas remains a challenging task in modern neurosurgery. Currently, various anterior and posterior approaches are used to remove such lesions.

Objective: To present a 14-year-old patient with giant chordoma at the level of intact clivus and C1-C3 vertebrae. Surgery implied combination of approaches without disturbing stability of craniovertebral junction.

Results. t: Umor in lateral parts of spinal canal was removed via posterior median access, and ventral fragment was excised through transoral access. Resection of lower sections of clivus (5 mm) and upper edge of anterior C1 semicircle (2 mm) expanded the angle of surgical action from 7 to 11⁰ and accessibility zone necessary for maximum tumor removal and decompression of brainstem and upper cervical spinal cord without compromising stability of craniovertebral junction.

Conclusion: Patients with giant neoplasms of craniovertebral junction require a personalized approach. Total resection of craniovertebral junction chordoma is often accompanied by unreasonably high risk of impaired quality of life. In our opinion, maximum possible resection safe for quality of life with brainstem decompression and subsequent radiotherapy is advisable.

Differentiation of high-grade gliomas (WHO grades III and IV) is still a pressing issue despite advances of molecular biology in tumor stratification. Even with a comprehensive approach to differential diagnosis, uncertainty sometimes arises in classifying a glioma into a particular grade. This can complicate prognosis and selection of appropriate treatment.

Objective: To develop an effective method for differentiating high-grade gliomas based on marker gene expression analysis.

Material and methods: We analyzed expression of 31 marker genes in high-grade glioma samples (Grade III and IV) diagnosed with isocitrate dehydrogenase (IDH)-mutated oligodendroglioma, IDH-mutated astrocytoma and IDH-wildtype glioblastoma. Real-time polymerase chain reaction was used. Spearman rank correlation method was applied to select genes whose expression was most closely related to glioma grade. Gene expression and their ratios were compared in groups of Grade III and IV malignant gliomas using the Mann-Whitney test.

Results: Expression ratios of three genes (CD44, CIRBP, and SOX2) were selected to assess malignancy grade. Expression ratios for these genes distinguishes IDH wild-type glioblastomas from IDH-mutated astrocytomas and oligodendrogliomas. They also have a stronger correlation with glioma grade than expression of each individual marker gene.

Conclusion: Original method based on marker gene expression ratios does not replace standard diagnostic protocols, but may be an additional tool for optimized diagnostic process. This approach will be valuable to minimize errors and personalize therapeutic strategies. The last one is critical for prognosis.