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The paper deals with the diagnostic potentialities of using various techniques in the wounded persons with arms-induced brain injuries. The diagnosis of arms-induced wounds of the skull and brain must be comprehensive and made concurrently with therapeutical measures. The instrumental methods must be applied to the extent accessible for the given wounded person and a study should be stopped immediately after a diagnosis is established.

Transcranial electric stimulation (TES), a combination of direct and pulse current totally up to 5 mA, rectangular impulses lasting 3-4 ms at a frequency of 75-80 Mz, via frontal and retromastoid electrodes was carried out for 30 minutes every other day. The treatment consisted of 7 to 10 sessions. Overall 189 patients suffering from vegetovascular dystonia were examined. Of these, 114 persons (group I) received pharmacotherapy and TES, 61 TES (group II), and 14 were on placebo. 83% of the group I patients and 80.3% of the group II patients manifested an appreciable improvement of the well-being which was supported by the data of its general estimation. 22 patients were examined for blood beta-endorphin. It has been shown that its concentration increased and returned to normal during TES.

In 6.6% of cases a severe craniocerebral trauma is accompanied with dislocation of the brain under the falx cerebri with incarceration of the cingulate gyrus. The diagnosis of dislocation under the falx in intracranial traumatic hematoma and brain contusion-crushing is discussed. Falxotomy may be among the methods for the prevention or correction of incarceration of the cingulate gyrus. The authors suggest an operative approach for performing falxotomy with little injury as well as a surgical instrument for one-stage clipping of the inferior sagittal sinus and its division.

The results of intracranial pressure measurement and different methods of draining the ventricles of the brain in severe craniocerebral injury are analysed. The authors examined 30 patients who had been operated on for intracranial hematomas and contusion of the brain. The importance of intracranial pressure gradients in the genesis of dislocation processes is emphasized. It is recommended that drainage of the ventricles of the brain is performed under continuous control of the intracranial pressure in both hemispheres.

The degree and duration of the effect of dehydration therapy on intracerebral pressure and local cerebral blood flow were studied. The record was taken by means of an original combined sensor implanted into the brain tissue during neurosurgical operations in patients with acute disorder of cerebral circulation of the hemorrhagic type and severe craniocerebral trauma. Urea, mannitol, and glucose were applied as the dehydration agents. They were infused intravenously with due account for the initial values of intracerebral and arterial pressure.

The work is based on the analysis of 450 patients with combined injury; 272 of them underwent osteosynthesis in different periods after the injury. Examination and treatment of the combined injuries must be conducted simultaneously. Operations on the extremities are performed only after the patient recovers from shock. Indications and contraindications for applying instrumental methods of examination are discussed. The volume of the neurosurgical intervention in patients with combined craniocerebral injury comprises removal of the hematoma, correction and prevention of dislocation and secondary compression of the brain stem in the postoperative period, and hemostasis. Preference is given to resection trephination and to encephalotomy for removing an intracerebral hematoma. Secondary stem disorders are managed by tentoriotomy; ventricular drainage is applied in hydrocephalus. A classification is suggested which takes into account the severity of the craniocerebral injury and the severity of the injury to the extremity.

The functional state of the kidneys in dynamics was investigated in 147 patients with severe cerebro-cranial injuries. Dynamic changes of the blood protein metabolites in patients with normal glomerular filtration and depressed one were contrasted. The declined glomerular filtration was found to be of a passing nature, being accompanied by an increased content of nitrous products in the blood. The relation of azotemia with both renal and extrarenal factors is stressed. A relationship between the glomerular filtration and an upset hemodynamics and dehydration, as well as the absence of its dependance on isolated respiratory distressed, changes in the level of plasmatic electrolytes and also on the nature of the brain lesion and the age of patients were established.

Dynamic X-ray follow-ups were conducted after pneumo-encephalography (PEG) of 28 patients who had suffered a severe craniocerebral trauma (intracranial hematoma, crushing of the brain), and those suffering from a post-traumatic disease of the brain. PEG was carried out in periods from 3 months to 3 years after the trauma had occurred. X-ray control was established immediately after the endolumbar infusion of air into the intracranial cerebrospinal fluid spaces, and subsequently every 24 hours till the complete disappearance of air from the ventricles of the brain. Investigation showed that in most cases a more reliable picture of the size of the ventricles can be obtained not on the day that PEG is performed, but in remoter periods (24--48 hours). The internal hydrocephaly that occurs in most patients is evidently of aresorptive character. The expansion of subarachnoidal spaces, rather than their obliteration, is more characteristic of a traumatic disease of the brain, including post-traumatic epilepsy. These changes, however, are not pathognomonic for a complicated severe craniocerebral trauma.

The clinical course and prognosis in the event of a severe cerebrocrainial trauma depend, above all, on the extent of the contusion and smashing of the brain sustained. The pathogenetic factor of prime importance determining the severity of the contusion is the development of the local and general cerebral edema. Rapidly accuring edema and turgescence of the brain, rising intracranial pressure lead to the dislocation of the brain attended by a clinical picture of a grave secondary lesion of the brain stem. To eliminate or prevent the emergence of the dislocation syndrome an operative removal of the primary contusion focus and concussory treatment of the brain in combination with the pathogenetic conservative therapy, aimed at preventing further progressive edema of the brain, are indicated in some of such patients.

An analysis of the results of a combined psychophysiological examination has demonstrated that the absence of marked clinical manifestations cannot be considered as a valid criterion justifying the denial or discontinuation of inpatient treatment. Hence, the results of psychophysiological examination may serve only as an additional criterion in the evaluation of the patients' condition.

An analysis of clinical and echoencephalographic studies in 100 patients permitted the author to detect a dependency between the clinical signs of frontal lobe lesions and the mechanisms of the inflicted trauma. A clarification of the character of the traumatic injury of the frontal lobe (contusion or contusion-crush) is very important inasmuch as it determines the medical tactics in relation to treatment. According to the data of the author, patients with contusions of the frontal lobes require conservative treatment, while in traumatical crushing of the frontal lobes surgical treatment may be frequently necessary.

Circulatory disorders in the brain stem due to temporal herniation are among the leading causes of death of patients with craniocerebral injuries. The dissection of the cerebellar tentorium following the removal of a space occupying formation aimed at decompressing the brain stem is a rather traumatizing procedure. A less traumatizing method of tentorial dissection was developed using a specially designed instrument. Fifteen operations were conducted in 14 patients.

The authors studied 428 case records of patients who had been treated at 9 multiprofile hospitals and died from a severe craniocerebral trauma. The defects revealed in aid given before hospitalization and in the hospital allowed the main principles of the organization to aid and treatment to be formulated: hospitalization of patients with severe craniocerebral trauma in specialized in-patient clinics; the conduct of a complex of neurosurgical examinations simultaneously and in parallel with resuscitation measures; early surgical intervention (within the first 3-6-8 hours after infliction of the trauma) which must be radical, i. e. including extensive trephination of the skull (osteoplastic or resection), total removal of intracranial hematomas and foci of contusion-crushing of the brain, active aspiration dosaged drainage of the postoperative wound and, whenever indicated, tentoriotomy (in specialized departments).

According to the authors, the clinical course of multiple intracranial haematomas is characterized by a prompt formation of the syndrome of acute brain dislocation with the development of severe pyramidal deficit and involvement of the oculomotor nerve on the side of the larger intracranial haematoma. To detect the multiple haematomas it is recommended to employ, both pre- and post-operatively, a careful echoencephalographic and angiographic control in the patients with a severe brain trauma.

The case records of 3,150 patients with severe forms of craniocerebral injury (intracranial hematomas, contusion and crushing of the brain) are analysed. The causes of fatal outcomes in surgical management of this contingent of patients are considered. Not only the time factor (operation performed within 3-6 hours after admission) but also the volume of the surgical intervention are determinant in the treatment of severe craniocerebral injury. The operation must be radical with removal of the hematoma and foci of brain contusion and must include measures for relieving the CSF system and freeing the brain stem from compression; a system of irrigation and active aspiration from the region of the cerebral wounds must be applied in the postoperative period.

Digital subtraction angiography (DSA) was used in the examination of 203 patients with various forms of acute diseases and injuries of the brain. The method of the examination is described and its advantages and shortcomings in each type of pathology are revealed. DSA meets the requirements placed upon angiographic examination of patients with acute diseases of the brain and craniocerebral injury and may be used successfully in the diagnosis of emergency neurosurgical conditions.

The results of surgical treatment of 110 patients with severe craniocerebral trauma and acute midbrain dislocation syndrome are discussed. The principal operation for removal of the injured site (hematoma or focus of brain crushing) was supplemented in all cases by mildly injurious tentoriotomy. As a result, lethality in the group of patients subjected to tentoriotomy decreased. Criteria (clinical, electrophysiological, and angiographic) are characterized on the basis of which the indications for tentoriotomy in craniocerebral trauma are determined.