Volodymyr O. Piatykop, Vladyslav I. Kaliuzhka, Mykyta A. Markevych, Iurii O. Babalian, Maksym M. Khaustov
Objective: to optimize surgical access to intracranial lesions (tumors, arteriovenous malformations, cysts, etc.) by using a holographic neuronavigation system with augmented reality helmet. Materials and methods: The study included thirty-four patients who underwent cerebral neurosurgical interventions. Creation and clinical use of mixed reality neuronavigation (MRN) system holograms was possible in all cases, which allowed accurate localization of lesions. The additional time required for synchronizing the MRN system with the clinical environment was estimated, which decreased with the number of MRN system uses. Operators evaluated the effectiveness of the technology and in most cases provided positive evaluations after use. Results: A semi-automatic MRN recording system on HoloLens smart glasses has been developed and tested for accuracy and performance. 34 patients with intracranial lesions were prospectively included in the study. Three-dimensional holograms of lesions, markers, and surrounding anatomical landmarks based on multimodal imaging were generated for each patient and then imported into the MRN system in AR helmet. After point recording, holograms were projected onto the patient’s head and observed through the AR helmet during the planning and conducting of surgical interventions. Conclusions: In this small pilot study, the authors found that mixed reality neuronavigation system MRN can be applied in the workflow of a neurosurgical operating room and is a possible method of preoperative identification of lesion boundaries for surgical access planning. Future studies are needed to identify strategies to improve and optimize the accuracy of MRN system.
{"title":"Own experience of using holographic neuronavigation using an augmented reality helmet in neurosurgery","authors":"Volodymyr O. Piatykop, Vladyslav I. Kaliuzhka, Mykyta A. Markevych, Iurii O. Babalian, Maksym M. Khaustov","doi":"10.25305/unj.284245","DOIUrl":"https://doi.org/10.25305/unj.284245","url":null,"abstract":"Objective: to optimize surgical access to intracranial lesions (tumors, arteriovenous malformations, cysts, etc.) by using a holographic neuronavigation system with augmented reality helmet. Materials and methods: The study included thirty-four patients who underwent cerebral neurosurgical interventions. Creation and clinical use of mixed reality neuronavigation (MRN) system holograms was possible in all cases, which allowed accurate localization of lesions. The additional time required for synchronizing the MRN system with the clinical environment was estimated, which decreased with the number of MRN system uses. Operators evaluated the effectiveness of the technology and in most cases provided positive evaluations after use. Results: A semi-automatic MRN recording system on HoloLens smart glasses has been developed and tested for accuracy and performance. 34 patients with intracranial lesions were prospectively included in the study. Three-dimensional holograms of lesions, markers, and surrounding anatomical landmarks based on multimodal imaging were generated for each patient and then imported into the MRN system in AR helmet. After point recording, holograms were projected onto the patient’s head and observed through the AR helmet during the planning and conducting of surgical interventions. Conclusions: In this small pilot study, the authors found that mixed reality neuronavigation system MRN can be applied in the workflow of a neurosurgical operating room and is a possible method of preoperative identification of lesion boundaries for surgical access planning. Future studies are needed to identify strategies to improve and optimize the accuracy of MRN system.","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yurii V. Cherednychenko, Rocco A. Armonda, Andrii H. Sirko, Mykola O. Zorin, Andrii Y. Miroshnychenko, Vadym A. Perepelytsia
Objective: Evaluate the possibilities of treating giant intracranial aneurysms and complex anatomy aneurysms by implanting new generation of FRED X flow diverters (MicroVention, USA) with antithrombogenic surface subject to preoperative virtual modeling and sizing with PreSize Neurovascular software (Oxford Heartbeat Ltd, Great Britain). Materials and Methods. FRED X flow diverters with antithrombogenic surface were implanted in 7 patients with giant cerebral aneurysms and complex anatomy aneurysms in the Endovascular Center at Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, within two months (May 2, 2023 to June 27, 2023). Our study group consisted of 4 (57.1%) female patients and 3 (42.9%) male patients (p=1.0). The average age was 50.4±13.7. 4 patients had single intracranial aneurysms and 3 patients had multiple aneurysms. 2 patients had 2 aneurysms and 1 patient had 4 aneurysms. 3 patients had a hemorrhagic clinical course of the disease (spontaneous subarachnoid hemorrhage in the history), 3 patients had asymptomatic aneurysms, and 1 patient had a pseudotumorous aneurysm. Results. All 7 patients underwent the ICA aneurysm(s) surgery. 3 patients had a flow diverter implanted at the level of multiple aneurysms (in 2 patients, 2 aneurysms; in 1 patient, 3 aneurysms). 2 patients, in addition to flow diverter implantation, underwent coil aneurysms embolization (using jailing technique). In all patients, the flow diverter was implanted under dual (ticagrelor and acetylsalicylic acid) antiplatelet therapy. 3 patients with a history of subarachnoid aneurysmal hemorrhage received a loading dose of dual antiplatelet therapy immediately before the flow diverter implantation. In one patient with a complex closed siphon shape, balloon angioplasty was required to optimize flow diverter opening to the arterial wall. In all other 6 patients, the flow diverters were opened in a controlled manner with a Push & Pull technique variant: Load/Tension Unsheath technique. Conclusions: In the endovascular treatment of giant and complex aneurysms, the use of new generation FRED X flow diverters (MicroVention, USA) with antithrombogenic coating subject to proper diverters sizing with PreSize Neurovascular software does not cause technical difficulties and is controlled.
{"title":"Intracranial aneurysms treatment using new generation FRED X flow diverters with antithrombotic coating and preoperative PreSize Neurovascular software simulation: literature review and own clinical observations analysis","authors":"Yurii V. Cherednychenko, Rocco A. Armonda, Andrii H. Sirko, Mykola O. Zorin, Andrii Y. Miroshnychenko, Vadym A. Perepelytsia","doi":"10.25305/unj.283904","DOIUrl":"https://doi.org/10.25305/unj.283904","url":null,"abstract":"Objective: Evaluate the possibilities of treating giant intracranial aneurysms and complex anatomy aneurysms by implanting new generation of FRED X flow diverters (MicroVention, USA) with antithrombogenic surface subject to preoperative virtual modeling and sizing with PreSize Neurovascular software (Oxford Heartbeat Ltd, Great Britain). Materials and Methods. FRED X flow diverters with antithrombogenic surface were implanted in 7 patients with giant cerebral aneurysms and complex anatomy aneurysms in the Endovascular Center at Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, within two months (May 2, 2023 to June 27, 2023). Our study group consisted of 4 (57.1%) female patients and 3 (42.9%) male patients (p=1.0). The average age was 50.4±13.7. 4 patients had single intracranial aneurysms and 3 patients had multiple aneurysms. 2 patients had 2 aneurysms and 1 patient had 4 aneurysms. 3 patients had a hemorrhagic clinical course of the disease (spontaneous subarachnoid hemorrhage in the history), 3 patients had asymptomatic aneurysms, and 1 patient had a pseudotumorous aneurysm. Results. All 7 patients underwent the ICA aneurysm(s) surgery. 3 patients had a flow diverter implanted at the level of multiple aneurysms (in 2 patients, 2 aneurysms; in 1 patient, 3 aneurysms). 2 patients, in addition to flow diverter implantation, underwent coil aneurysms embolization (using jailing technique). In all patients, the flow diverter was implanted under dual (ticagrelor and acetylsalicylic acid) antiplatelet therapy. 3 patients with a history of subarachnoid aneurysmal hemorrhage received a loading dose of dual antiplatelet therapy immediately before the flow diverter implantation. In one patient with a complex closed siphon shape, balloon angioplasty was required to optimize flow diverter opening to the arterial wall. In all other 6 patients, the flow diverters were opened in a controlled manner with a Push & Pull technique variant: Load/Tension Unsheath technique. Conclusions: In the endovascular treatment of giant and complex aneurysms, the use of new generation FRED X flow diverters (MicroVention, USA) with antithrombogenic coating subject to proper diverters sizing with PreSize Neurovascular software does not cause technical difficulties and is controlled.","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: to evaluate the effectiveness and safety of different operations in children with drug-resistant epilepsy. Materials and Method. 91 children with drug-resistant epilepsy were enrolled in a retrospective study. Mean age was 10.3±5.1 years. Anterior temporal lobectomy was performed in 16 (57.1%) patients, lesionectomy – in 9 (10.0%), microsurgical callosotomy in 18 (19.8%), stereotactic callosotomy in 7 (7.7%), multifocal resections in 4 (4.4%), functional hemispherotomy in 14 (15.6%). Stereotactic radiofrequency callosotomy was performed on a CRW Stereotactic frame (Radionics Inc., USA). Ultrasound navigation and neuronavigation were used in 6 (7%) and 14 (15%) cases correspondingly. Intraoperative corticography was applied in 8 (9%) cases. Postoperative long-term follow-up lasted from 1 to 17 years (mean - 8.2±2.1 years). Results. An epileptogenic zone within single hemisphere was indentified in 66 (72.2%) cases, while bilateral epileptiform activity was observed in 25 (27.5%) children. The most common etiologies of epilepsy included hypoxic-ischemic encephalopathy, intracerebral hemorrhage, meningoencephalitis, Rasmussen syndrome, cortical dysplasia, tumors.After surgery 51 (56%) patients became seizures free (Engel 1), 14 (15.4%) patients had rare auras or focal seizures (Engel 2). In 25 (27.5%) cases, seizure frequency reduction was less than 75% or did not change significantly. The most favorable outcomes were associated with resection procedures, resulting in complete seizure control in 46 (69.7%) out of 66 children, with significant improvement observed in 9 (13.6%) cases. After callosotomy drop-attacks stopped in 14 (78%) out of 18 who had them before surgery. Operative complications were encountered in 6 (6.6%) cases, postoperative mortality occurred in 1 (1.1%) case. Conclusions. The key to the effectiveness of surgical treatment of childhood epilepsy is early surgical intervention, which leads to the control of epileptic seizures, correction of psychological and cognitive emotional disorders and improvement of quality of life. The combination of resection procedures and disconnections contributes to the reduction of epileptogenic neurons and suppression of epileptic discharges.
{"title":"Our experience of pediatric epilepsy surgery","authors":"Kostiantyn R. Kostiuk, Viacheslav M. Buniakin","doi":"10.25305/unj.282642","DOIUrl":"https://doi.org/10.25305/unj.282642","url":null,"abstract":"Objective: to evaluate the effectiveness and safety of different operations in children with drug-resistant epilepsy. Materials and Method. 91 children with drug-resistant epilepsy were enrolled in a retrospective study. Mean age was 10.3±5.1 years. Anterior temporal lobectomy was performed in 16 (57.1%) patients, lesionectomy – in 9 (10.0%), microsurgical callosotomy in 18 (19.8%), stereotactic callosotomy in 7 (7.7%), multifocal resections in 4 (4.4%), functional hemispherotomy in 14 (15.6%). Stereotactic radiofrequency callosotomy was performed on a CRW Stereotactic frame (Radionics Inc., USA). Ultrasound navigation and neuronavigation were used in 6 (7%) and 14 (15%) cases correspondingly. Intraoperative corticography was applied in 8 (9%) cases. Postoperative long-term follow-up lasted from 1 to 17 years (mean - 8.2±2.1 years). Results. An epileptogenic zone within single hemisphere was indentified in 66 (72.2%) cases, while bilateral epileptiform activity was observed in 25 (27.5%) children. The most common etiologies of epilepsy included hypoxic-ischemic encephalopathy, intracerebral hemorrhage, meningoencephalitis, Rasmussen syndrome, cortical dysplasia, tumors.After surgery 51 (56%) patients became seizures free (Engel 1), 14 (15.4%) patients had rare auras or focal seizures (Engel 2). In 25 (27.5%) cases, seizure frequency reduction was less than 75% or did not change significantly. The most favorable outcomes were associated with resection procedures, resulting in complete seizure control in 46 (69.7%) out of 66 children, with significant improvement observed in 9 (13.6%) cases. After callosotomy drop-attacks stopped in 14 (78%) out of 18 who had them before surgery. Operative complications were encountered in 6 (6.6%) cases, postoperative mortality occurred in 1 (1.1%) case. Conclusions. The key to the effectiveness of surgical treatment of childhood epilepsy is early surgical intervention, which leads to the control of epileptic seizures, correction of psychological and cognitive emotional disorders and improvement of quality of life. The combination of resection procedures and disconnections contributes to the reduction of epileptogenic neurons and suppression of epileptic discharges.","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitalii I. Tsymbaliuk, Milan V. Vorodi, Taras I. Petriv, Iaroslav V. Tsymbaliuk, Oleksii S. Nekhlopochyn
Traction injury of the peripheral nerve (TIPN) is an injury that occurs as a result of stretching the nerve beyond its normal elastic properties. An analysis of the available literature has revealed the following. TIPN is the most common type of severe nerve injury in the setting of road traffic accidents, catatrauma, gunshot wounds, birth injuries, etc. The dynamics of TIPN during fast and slow stretching is the same and includes three phases: elastic, inelastic and tearing. The limits of elastic stretching of the nerve are determined by the degree of tortuosity of myelinated fibers and the elasticity of the connective tissue framework of the nerve. Stretching of the nerve beyond its elastic limits is characterized by rupture of axons and endoneurial sheaths, including at a considerable distance from the epicenter of pathomorphological changes, which determines the severity of the injury and the impossibility of effective nerve autoregeneration. The force of stretching and the direction of its application to the nerve trunk determine the severity of TIPN. The degree of nerve stretching varies along its length and reaches a maximum in the periarticular areas. A fairly moderate stretching of the nerve can lead to a noticeable change in the conductivity of electrical impulses. Unlike other localized types of nerve injury, the pattern of pathomorphological changes in TIPN includes various forms of damage to structural elements. Understanding the pathophysiology of TIPN is a prerequisite for the development of optimal treatment of this type of injury.
{"title":"Peripheral nerve traction injury. Literature review","authors":"Vitalii I. Tsymbaliuk, Milan V. Vorodi, Taras I. Petriv, Iaroslav V. Tsymbaliuk, Oleksii S. Nekhlopochyn","doi":"10.25305/unj.281796","DOIUrl":"https://doi.org/10.25305/unj.281796","url":null,"abstract":"Traction injury of the peripheral nerve (TIPN) is an injury that occurs as a result of stretching the nerve beyond its normal elastic properties. An analysis of the available literature has revealed the following. TIPN is the most common type of severe nerve injury in the setting of road traffic accidents, catatrauma, gunshot wounds, birth injuries, etc. The dynamics of TIPN during fast and slow stretching is the same and includes three phases: elastic, inelastic and tearing. The limits of elastic stretching of the nerve are determined by the degree of tortuosity of myelinated fibers and the elasticity of the connective tissue framework of the nerve. Stretching of the nerve beyond its elastic limits is characterized by rupture of axons and endoneurial sheaths, including at a considerable distance from the epicenter of pathomorphological changes, which determines the severity of the injury and the impossibility of effective nerve autoregeneration. The force of stretching and the direction of its application to the nerve trunk determine the severity of TIPN. The degree of nerve stretching varies along its length and reaches a maximum in the periarticular areas. A fairly moderate stretching of the nerve can lead to a noticeable change in the conductivity of electrical impulses. Unlike other localized types of nerve injury, the pattern of pathomorphological changes in TIPN includes various forms of damage to structural elements. Understanding the pathophysiology of TIPN is a prerequisite for the development of optimal treatment of this type of injury.","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oleksii S. Nekhlopochyn, Maksym M. Pylypenko, Sergii O. Dubrov
One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the spe
{"title":"Vascular injury during lumbar discectomy: risk factors, diagnosis, methods of surgical correction, features of anaesthetic management and intensive care","authors":"Oleksii S. Nekhlopochyn, Maksym M. Pylypenko, Sergii O. Dubrov","doi":"10.25305/unj.281502","DOIUrl":"https://doi.org/10.25305/unj.281502","url":null,"abstract":"One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the \"most typical\" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the spe","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135476357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mykhailo P. Komarov, Oleksii S. Nekhlopochyn, Vadim V. Verbov, Oksana H. Chernenko, Anna A. Shmelova, Ievgen V. Cheshuk, Tetiana A. Malysheva
Chondroblastoma (CB) ‒ a rare benign tumor of the skeleton that is presented by proliferation of chondroblasts with islands of eosinophilic chondroid matrix. CB accounts for less than 1% of all bone neoplasms, while the spine is affected in only 1.4% of all CB cases. Publications devoted to CB of the spine are sporadic and therefore have a considerable scientific interest due to the rarity of the pathology. A clinical case of CB of the cervical-thoracic junction of a 38-year-old patient hospitalized to State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine" in November 2022 is presented. The anamnesis shows that in 2016 a pathological fracture of the Th2 vertebral body was diagnosed. In 2017, a surgical intervention - an open biopsy of the Th2 vertebral arch was performed in a private clinic, but the histopathological analysis, due to the insufficient amount of material and the absence of clinical data, was descriptive, with a certain diagnostic number of possible nosologies. Additional treatment was not performed. When applying in 2022 to the State Institution "Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine", significant negative dynamics were noted: a fracture of the body of the Th1 vertebra, total destruction of the body of the Th2 vertebra, a change in the signal from the body of the Th3 vertebra, which indicated its focal lesion. The surgery was performed in two stages. The first stage included a ventral corpectomy of the Th1‒Th3 vertebrae with fusion using telescopic body replacement implant and a ventral rigid plate. During the second stage laminectomy of the Th1‒Th3 vertebrae with complete resection of the Th2 costotransverse joints and partial of Th1‒Th3 ones was performed. Stabilization system screws were installed transarticularly in the facet joints C6 and C7, transpedicularly in the bodies of the Th4‒Th6 vertebrae. To increase the fusion rigidity, additional fixation of the Th1 vertebra on the right and the Th3 vertebra on the left was performed through the remaining costotransverse joints. The patient was discharged with positive neurological dynamics. The uniqueness of this case, in addition to the rarity of the histological variant of the pathology, lies in the possibility of tracking the dynamics of the disease on the basis of both neuroimaging methods and pathohistological and immunohistochemical diagnostics. Features of the prevalence of spine CB in the population, the specifiс signs when performing a spiral computer and magnetic resonance imaging, macroscopic, histological and immunohistochemical characteristics of the tumor are considered in detail. The literature data on differential diagnosis, treatment methods and prognosis of disease are organized. The material is of interest to specialists, since the timely selection of an adequate treatment method and its volume determines both the probability of tumor recurrence as well as prognosis concerning
{"title":"Chondroblastoma of the cervical-thoracic junction: global data and own experience","authors":"Mykhailo P. Komarov, Oleksii S. Nekhlopochyn, Vadim V. Verbov, Oksana H. Chernenko, Anna A. Shmelova, Ievgen V. Cheshuk, Tetiana A. Malysheva","doi":"10.25305/unj.277910","DOIUrl":"https://doi.org/10.25305/unj.277910","url":null,"abstract":"Chondroblastoma (CB) ‒ a rare benign tumor of the skeleton that is presented by proliferation of chondroblasts with islands of eosinophilic chondroid matrix. CB accounts for less than 1% of all bone neoplasms, while the spine is affected in only 1.4% of all CB cases. Publications devoted to CB of the spine are sporadic and therefore have a considerable scientific interest due to the rarity of the pathology. A clinical case of CB of the cervical-thoracic junction of a 38-year-old patient hospitalized to State Institution \"Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine\" in November 2022 is presented. The anamnesis shows that in 2016 a pathological fracture of the Th2 vertebral body was diagnosed. In 2017, a surgical intervention - an open biopsy of the Th2 vertebral arch was performed in a private clinic, but the histopathological analysis, due to the insufficient amount of material and the absence of clinical data, was descriptive, with a certain diagnostic number of possible nosologies. Additional treatment was not performed. When applying in 2022 to the State Institution \"Romodanov Neurosurgery Institute of the National Academy of Sciences of Ukraine\", significant negative dynamics were noted: a fracture of the body of the Th1 vertebra, total destruction of the body of the Th2 vertebra, a change in the signal from the body of the Th3 vertebra, which indicated its focal lesion. The surgery was performed in two stages. The first stage included a ventral corpectomy of the Th1‒Th3 vertebrae with fusion using telescopic body replacement implant and a ventral rigid plate. During the second stage laminectomy of the Th1‒Th3 vertebrae with complete resection of the Th2 costotransverse joints and partial of Th1‒Th3 ones was performed. Stabilization system screws were installed transarticularly in the facet joints C6 and C7, transpedicularly in the bodies of the Th4‒Th6 vertebrae. To increase the fusion rigidity, additional fixation of the Th1 vertebra on the right and the Th3 vertebra on the left was performed through the remaining costotransverse joints. The patient was discharged with positive neurological dynamics. The uniqueness of this case, in addition to the rarity of the histological variant of the pathology, lies in the possibility of tracking the dynamics of the disease on the basis of both neuroimaging methods and pathohistological and immunohistochemical diagnostics. Features of the prevalence of spine CB in the population, the specifiс signs when performing a spiral computer and magnetic resonance imaging, macroscopic, histological and immunohistochemical characteristics of the tumor are considered in detail. The literature data on differential diagnosis, treatment methods and prognosis of disease are organized. The material is of interest to specialists, since the timely selection of an adequate treatment method and its volume determines both the probability of tumor recurrence as well as prognosis concerning","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oleksii S. Nekhlopochyn, Vadim V. Verbov, Ievgen V. Cheshuk, Milan V. Vorodi
More than 60% of traumatic injuries of the spine occur in the zone of the thoracolumbar junction (TLJ), and 60–75% of these fractures are of a compression nature. Type A1 injuries are characterized by the least osteo-destructive changes compared to other injuries. Traditionally, they are treated conservatively. A number of studies conducted in the last 10 years, shows a high rate of failure of conservative treatment, as evidenced by the progression of kyphotic deformity of the compressed vertebral body. Most of these publications are devoted to osteoporotic lesions in aged patients, while this aspect has been little studied in patients of working age with normal bone density. Objective: to evaluate the factors influencing the risk of kyphotic deformity progression in patients of working age with type A1 traumatic injuries of the thoracolumbar junction. Materials and methods. The analysis of clinical cases of patients who visited the outpatient department of Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2019 to 2022 with traumatic damage to the TLJ zone. Forty-seven victims who met the selection criteria were selected. Gender, age, body mass index, level of damage, location of the damaged endplate (caudal or cranial), bone tissue radiodensity, angular kyphotic deformity of the vertebral body, and pain intensity were considered as predictors. Depending on the presence or absence of deformity progression 2 months after the injury, the patients were divided into two clinical groups. The most clinically significant predictors were identified using the LASSO (Least Absolute Shrinkage and Selection Operator) regression method. Results. LASSO screening identified five potential predictors. The final logistic regression model after regularization demonstrated high predictive performance: the area under the ROC curve (AUC) was 0.907, and the predictive accuracy was 85%. When assessing the risk of kyphotic deformity progression in traumatic injuries of type A1 of the TLJ zone, age, bone density, angular kyphotic deformity of the vertebral body, and pain intensity are of the greatest importance, demonstrating a directly proportional relationship. A compressed caudal endplate is also associated with a higher risk of post-traumatic progression of angular kyphosis. The nomogram developed using the mentioned factors makes it possible to quantify the degree of risk when choosing a therapy strategy. Conclusions. The performed analysis made it possible to create a nomogram for predicting the increase in kyphotic deformity of the vertebral body in A1 fractures of TLJ region. The proposed model can be used for a rational assessment of the risk degree when choosing the optimal tactics for treating patients.
{"title":"Assessment of risk factors for the vertebral body kyphotic deformity progression in patients with type A1 injuries of the thoracolumbar junction","authors":"Oleksii S. Nekhlopochyn, Vadim V. Verbov, Ievgen V. Cheshuk, Milan V. Vorodi","doi":"10.25305/unj.278927","DOIUrl":"https://doi.org/10.25305/unj.278927","url":null,"abstract":"More than 60% of traumatic injuries of the spine occur in the zone of the thoracolumbar junction (TLJ), and 60–75% of these fractures are of a compression nature. Type A1 injuries are characterized by the least osteo-destructive changes compared to other injuries. Traditionally, they are treated conservatively. A number of studies conducted in the last 10 years, shows a high rate of failure of conservative treatment, as evidenced by the progression of kyphotic deformity of the compressed vertebral body. Most of these publications are devoted to osteoporotic lesions in aged patients, while this aspect has been little studied in patients of working age with normal bone density. Objective: to evaluate the factors influencing the risk of kyphotic deformity progression in patients of working age with type A1 traumatic injuries of the thoracolumbar junction. Materials and methods. The analysis of clinical cases of patients who visited the outpatient department of Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2019 to 2022 with traumatic damage to the TLJ zone. Forty-seven victims who met the selection criteria were selected. Gender, age, body mass index, level of damage, location of the damaged endplate (caudal or cranial), bone tissue radiodensity, angular kyphotic deformity of the vertebral body, and pain intensity were considered as predictors. Depending on the presence or absence of deformity progression 2 months after the injury, the patients were divided into two clinical groups. The most clinically significant predictors were identified using the LASSO (Least Absolute Shrinkage and Selection Operator) regression method. Results. LASSO screening identified five potential predictors. The final logistic regression model after regularization demonstrated high predictive performance: the area under the ROC curve (AUC) was 0.907, and the predictive accuracy was 85%. When assessing the risk of kyphotic deformity progression in traumatic injuries of type A1 of the TLJ zone, age, bone density, angular kyphotic deformity of the vertebral body, and pain intensity are of the greatest importance, demonstrating a directly proportional relationship. A compressed caudal endplate is also associated with a higher risk of post-traumatic progression of angular kyphosis. The nomogram developed using the mentioned factors makes it possible to quantify the degree of risk when choosing a therapy strategy. Conclusions. The performed analysis made it possible to create a nomogram for predicting the increase in kyphotic deformity of the vertebral body in A1 fractures of TLJ region. The proposed model can be used for a rational assessment of the risk degree when choosing the optimal tactics for treating patients.","PeriodicalId":477324,"journal":{"name":"Ukrainian neurosurgical journal","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：