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86 patients with posttraumatic defects of median and ulnar nerves were examined. Autoneuroplasty was performed at all of patients: in 42 cases--in combination with sympathectomy (thoracoscopic clipping of Th3-4 sympathetic ganglions), in 44 cases--without sympathectomy. Ultrasonography of nerve trunks, stimulation electroneuromyography, computer thermography, laser Doppler flowmetry with spectral wavelet-analysis of blood flow oscillations were used during checkup. For the first time was shown that induced sympathectomy has positive activating influence on restoring innervation and tissue trophics in the course of posttraumatic nerve regeneration. Combination of autoneuroplasty with induced sympathectomy contributes to a more complete restoration of motor and sensory nerve fibres, helps to normalize blood flow in microvascular bed and thermotopography of the damaged segment of the extremity including the previously denervated area.

On the basis of treatment results of 28 patients, the authors suggested that the clinical method of diagnostics allowed performance of topical diagnostics of injury using bedside test. It would help to choose a therapeutic approach in each clinical case.

The review deals with recent medical methods of reconstruction of peripheral nerve injuries, especially using the technology of nerve guidance conduits (NGCs), as well as scientific and applied prospects of further development of clinical and technical research in this area. In neurosurgery established techniques for the treatment of peripheral nerve injures include the matching and suturing of severed nerve fibers (however, it is important to avoid tension in gaps for effective regeneration of the nerve fiber), as well as allo/autologous nerve grafting for larger gaps (gold standard of repair). Unfortunately, this treatment is not always feasible in a number of clinical situations, has drawbacks and is associated with a potential risk of postoperative complications; in particular applying of donor transplants is complicated immunological incompatibility reactions. The use of implantable artificial tunneling device known as a nerve guidance conduit is an alternative method of reconstruction, contributing to the physiological regeneration of nerve fiber. The article describes technical engineering constructions - including by using various non- and biomaterials, liquid metals, light/laser, methods of electrospinning and microstereolithography - which are either commercially available or pre-tested and clinical studies detailing outcomes and reconstructive options. The review emphasizes that the further development of scientific research in the field of new materials and polymers, as well as techniques for the preparation and implantation of nerve conduits and their subsequent practical assessment is necessary for clinical medicine and rehabilitation.

The study was conducted on 6 female and 36 male adult Wistar rats to compare the effects of dissociated cells derived from different embryonic CNS anlages, on the growth of regenerating nerve fibers in the damaged nerve of the recipient. After the sciatic nerve was damaged by ligation, part of the animals received the injection into the proximal portion of the nerve with a suspension of the cells obtained by dissociation of the fragments of spinal cord or forebrain vesicle taken from rat embryos at Day 15 of development. The analysis of transverse semithin sections of the distal part of the nerves was performed 21 and 60 days after surgery. It was found that the number of regenerating myelinated nerve fibers was increased 60 days after the injection of dissociated embryonic spinal cord cells, but not the neocortical cells into the damaged nerve of the recipient.

Using the inverted phase-contrast microscope, the living undamaged frog sciatic nerve fibers and the fibers mechanically injured to varying degrees, were studied. It was found that the swelling of myelin incisures (MI) (of Schmidt-Lanterman) occured according to the principles similar to those controlling the changes of the myelin gap (node of Ranvier) and depended on the swelling of a Schwann cell (SC) perikaryon. It was detected that this was a single process, which which could be united in a complex of nonspecific changes of a myelinated nerve fiber. It was also demonstrated that under the action of mechanical injury and hypotonic solution, swelling of MI, nodes of Ranvier and SC perikaryon occurred without modifications of outer fiber diameter, due to the pronounced local axon thinning. Electron microscopic study of the cytoskeletal axonal structures showed that there was not a simple local contraction of an axon, but a significant local increase in the density of cytoskeletal components of the axoplasm (by 200-275%). Reactive reversible remodeling of a myelinated fiber suggests a new type of interaction between the axon and SC, the mechanism of reversible translocation of liquid axoplasmic fraction to the glial cell cytoplasm.

The authors discuss specific using minimally invasive surgical technique of ablation of the saphenous vein trunks by a modified Oesch PIN stripper method proposed by the authors. An experience with surgical treatment of 245 patients with varicose veins using the same modified technique is analyzed. Postoperative complications and medium-term results are evaluated.

A topometameric classification of mechanical injuries of the locomotor apparatus has been developed specially for the traumatologist's automatic information and retrieval system (TAIRS). The classification is intended for formalized characterization of mechanical injuries. The purpose of making this formalized diagnosis of an injury is to obtain an injury code by which, on the basis of laid expert assessments, TAIRS gives recommendations how to treat a patient by taking into account the specialization of a health institution.

Verospiron and lasix in combination with potassium orotate were studied for effects on hydroion balance, plasma renin activity, the levels of angiotensin, aldosterone, and prostaglandins E and F in various viscera 3 months after neurorrhaphy of the fibular nerve in rabbits. In the early reinnervation period, specific changes were found in water-electrolyte and hormonal status. The application of dehydrating agents was demonstrated to correct the disorders found.

Frequency of the appearance of neurological disturbances was studied after operative treatment of varicose disease in 422 patients. The topographo-anatomical correlations of subcutaneous nerves and lower extremity veins were also investigated in 40 corpses. The authors' original method was used in operations on 82 patients. Neurological disturbances-such as disturbances of skin sensitivity-were noted in 38.6% of the investigated people. Their cause is thought to be the mutual sheath between the subcutaneous vein and nerves in the shin. The endovasal autovenous occlusion of the main trunks of the subcutaneous shin vein with the help of the autovein taken from the thigh was made to avoid traumatism.

The cut sciatic nerve trunk was sutured perineurally to study in chronic rabbit experiments of the neuromuscular functional recovery upon the exposure to impulse magnetic field with the intensity 1.2 T. Nonexposed animals served control. Myographic activity of reinnervated crural muscles in the irradiated animals recovered two times more rapidly compared to the controls, so did motor function of the limb operated on. It is inferred that impulse magnetic field produces therapeutic and preventive effect on neurodystrophy resultant from the nerve dissection.

Overall 350 patients with the crush syndrome were examined. It has been shown by the clinico-neurological investigation that in long compression of the limbs followed by the development of the crush syndrome, sensitive fibers and the membrane of the axon are most of all exposed to unfavourable effects. The changes discovered as a result of the clinically intact nerves point to the diffuse impairment of the peripheral neuromotor apparatus in patients with the crush syndrome.

Spinal cord and cerebral cortex of 14-day-old embryos of Wistar rats were implanted into the sciatic nerve of mature rats in order to study dynamics of the development of neuronal and neuroglial elements in ectopic sites. By means of light and electron microscopy it has been stated that the implanted nerve cells of the cortex and spinal cord survive during 5 month and differentiate from neuroepithelial cells and neuroblasts up to young and mature neurons. It was found that thirty days after operation the spinal cord implants contained myelinated nerve fibers and numerous synapses. The data obtained suggest that the implants of fetal spinal cord are more favorable for regeneration of the injured nervous stems than the cerebral cortex.

A correlation between morphological and electrophysiological indices in the experimental alloneuroplastic of the sciatic nerve defect by the cryopreserved graft was determined. Data obtained permit recommending alloneuroplastic by cryopreserved graft for treatment of the peripheral nerve damage.

From clinical experience and the results of anatomical study, the authors suggest repairing defects in the large nerve trunks with segments of cutaneous nerves found within the boundaries of the main operative wound. As a result the commonly performed additional intervention on the healthy extremity for obtaining the graft is avoided. After the ends of the injured nerve are separated into bundles, the donor nerves are sutured to the groups of bundles so that the defect is repaired along the perimeter. Knowledge of the specific features of the fascicular structure of nerves allows the possibilities of microsurgery to be used more rationally neuroplasty.

The late results of nerve suture were studied in 398 patients with injury of one or more nerves and coding cards containing formalized data of the primary examination of the patients and the operative data were filled in. After mathematical processing of these data on an electronic computer (CBM-6000) using the linear regression method, 4 formulas were obtained from which a physician practicing in any field of medicine can prognosticate in 5-7 min the degree of restoration of the limb function and the working rehabilitation of individuals who had suffered injury of the nerves.

The authors studied the results of allotransplantation of fresh, frozen, preliminarily degenerated and irradiated, and stored in a nutrient medium under deep-freeze conditions nerve segments. Satisfactory results were registered only in transplantation of irradiated transplants. Evidence of this was provided by morphologic and electrophysiologic data and by microangiograms of their arterial network.

It is shown in experiments on 36 dogs that two-stage microsurgical autoneuroplasty with subsequent administration of an inhibitor of proteolytic enzymes (aminocaproic acid), an antioxidant (tocopherol acetate) and heparin makes it possible to realize more fully the histoblastic potencies of tissues which are components of the injured nerve and the graft. This circumstance leads to the improvement of the morphofunctional results of sciatic nerve restoration after its experimental injury.

On the basis of examination of 130 patients, the authors describe for the first time the thermovision syndromes of cerebral tumors, intracranial hematomas, posttraumatic cranial defects, tumors of the spinal cord, Schmorl' body, injuries to the peripheral nerves, and some other neurosurgical pathologic conditions. The mechanisms of the origin of thermoasymmetry are discussed. The diagnostic possibilities and the prospects of thermovision in neurosurgery are disclosed.

The equipment for, and methods of thermovisional examinations developed by the authors and used in 300 patients with focal pathologies of the central and peripheral nervous system are described. In patients with intracranial processes, local changes of the skin temperature on the head usually correlating with the loci of the brain pathology are revealed. The correlation between the asymmetry of the thermal fields and the tumour localization in relation to the brain surface was found to be regular. Peculiarities of the thermographic picture are described with reference to the histobiological characteristics of the tumours. In meningiomas, the zone of the increased luminosity was rounded, homogenous and distinctly outlined; in gliomas reaching the brain surface, this zone is diffuse and less intense. Thermovisional characteristics of traumatic meningeal hematomas with regard to the time of their formation are presented. Acute hematomas were characterized by a lowered skin temperature above them, chronic ones by a brighter luminosity in the zone of their localization. For the first time the thermovisional syndrome of the traumatic foci of brain contusion and smashing is described. Thermovisional appearance of spinal cord tumours, intervertebral disc hernias, injures of peripheral nerves, etc. is also presented.

From the examination of 915 patients with neurosurgical pathology the authors showed the possibility of mediated thermoimaging of localized lesions in the brain, spinal cord, and peripheral nerves. The combination of local and distant thermoasymmetries which are realized through reflex mechanisms of vegetovascular innervation is a characteristic feature of the thermovision syndromes in the infrared wave bands. It was proved experimentally and clinically that radiothermometry in the millimeter and centimeter wave bands yields information on the temperature of the surface and deep-seated cerebral tissues through the hairs on the head.

Among 12,476 patients with diseases of the peripheral nervous system 54.3% had radical syndromes, 16.3% had acute injuries of the nerves, 25.2% had entrapment syndromes, 3.8% suffered from polyneuropathies and other diseases. Entrapment syndromes were encountered in 3143 patients. Carpal, ulnar, and tarsal canal syndromes, thoracic outlet syndrome, and syndromes of entrapment of the radial and peroneal nerves prevailed. A total of 763 operations were performed for the entrapment syndromes. The distribution of the syndromes and operations is shown in the table. From 10 to 20% of patients with tunnel syndromes needed surgical treatment. From 12 to 34 upper extremities were operated on annually per 100,000 population for the carpal tunnel syndrome; 90% of the operations were performed at out-patient clinics. Interfascicular neurolysis by means of microsurgical techniques was conducted mainly in the cubital tunnel syndrome. Operations in entrapment lesions are marked by high efficacy.

The use of hyperbaric oxygenation (HBO) as a therapeutic measure has a favorable effect, in the postoperative period also, on traumatic affections of different levels of the nervous system (the brain, spinal cord, peripheral nerve trunks and plexuses. It allows the severity of the neurologic deficit and the degree of the patient's disability to be reduced and in some cases it prevents the growth of vital disorders. At the same time, the effect may exert a certain load on the adaptation mechanisms which are very limited in many neurosurgical patients. In view of this, the tolerance of the patient's organism to this load must be taken into account in choosing the HBO schedules. The tolerance is decisively determined by the intactness of the integral function of the central nervous system and diminishes markedly as the impairment of the consciousness of patients with primary affection of the brain gradually becomes deeper and longer in duration.

The mechanisms of the functional and structural brain plasticity which are the basis of the function restoration after central and peripheral lesions of the nervous system are considered. Some possible ways of neural activity disorders compensation are pointed out.

It was demonstrated in experiments on 24 dogs that microsurgical epineurectomy of a cryopreserved peripheral nerve improves the results of neuroplasty due to acceleration and increase of graft revascularization. From application of the developed method in 12 patients it was concluded that microsurgical alloneuroplasty with a cryopreserved graft may be the method of choice in cases in which autoplasty cannot be performed.