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Enterococcus-associated ventriculitis and meningitis are rare manifestations of enterococcal infection, but they are an infection with dire consequences in patients with neurosurgical pathology, since despite the availability of a large number of antibacterial drugs, the optimal approach to the treatment of enterococcal ventriculitis has not currently been established. In this article we present a description of a clinical case of a 1 year and 4 month old child who was hospitalized with signs of dysfunction of the shunt system and intoxication. During the audit of the shunt system, dysfunction of the ventricular end of the shunt system was discovered. In the postoperative period, the patient showed signs of ventriculitis, and bacteriological examination of the cerebrospinal fluid revealed Enterococcus durans. After combined antibacterial therapy for enterococcus-associated ventriculitis, the ventriculoperitoneal shunt was reinstalled. During treatment for bacterial ventriculitis, the patient developed signs of disseminated intravascular coagulation (DIC), which were relieved with hemostatic drugs and transfusion of blood components. The patient was safely discharged with improvement thanks to effective combination antibacterial therapy, timely detection and treatment of DIC syndrome. Thus, if there are signs of ventriculitis in a patient with a ventriculoperitoneal shunt, it is extremely important to identify the cause of inflammation and exclude possible dysfunction of the shunt system. And during the selection of treatment tactics, in order to achieve higher concentrations of the antibiotic in the cerebrospinal fluid, one should consider the use of combination antibacterial therapy as a more effective way to treat bacterial ventriculitis. [ABSTRACT FROM AUTHOR]

Vitamin C is a key antioxidant and immunomodulator. Viral infections are characterized by a considerable decrease in the concentration of vitamin C, and this deficiency plays a decisive role in the pathogenesis of herpes zoster (Herpes zoster, HZ) and in the development of postherpetic neuralgia (PHN). Although management strategies for both acute pain caused by HZ and chronic PHN are constantly at the center of discussion, the treatment of this pathology still presents many challenges. It is assumed that a significant therapeutic effect can be obtained from the use of vitamin C, especially in the early stages of the manifestation of herpes infection. Moreover, to achieve such an effect, high concentrations of vitamin C in plasma are required, which are achieved only by intravenous (iv) administration in high doses in grams. Analysis of the literature shows a rapidly growing interest in the use of high IV doses of vitamin C as an adjuvant therapy for various infections. The results obtained strongly support this therapeutic approach. The purpose of this review is to assess the biological rationale and efficacy of high IV doses of vitamin C in HZ. [ABSTRACT FROM AUTHOR]

In order to begin clinical trials of drugs and medical devices, preclinical studies are required. To conduct an experimental preclinical study on animals (dogs, rabbits or rats), it is necessary to correctly calculate the dose of drugs for anesthesia, to be fluent in the technique of craniotomy on animals, to perform a painless euthanasia procedure, etc. We conducted a review of scientific and technical literature over the past 30 years, as a result of which we analyzed the main recommendations for anesthesia, craniotomy, and euthanasia when working with experimental animals. Due to the relative ease of caring for them and their availability, we chose rabbits as test animals. Taking into account such characteristics of these animals as low weight and high metabolic rate, due to which the effect of many injectable agents may be shorter, the following recommendations were highlighted: 1) when calculating the dose of drugs for anesthesia, it is necessary to take into account the actual weight of the animal at the time of surgery; 2) do not expose rabbits to prolonged hunger and dehydration. P. Alberius very carefully described the features of craniotomy in rabbits, paying great attention to antibiotic prophylaxis, replenishment of circulating blood volume (BCC) during surgery, as well as the prevention of hypothermia during and after surgery. Rabbit euthanasia is often carried out with carbon dioxide (CO2), with the benefits of being economical and relatively safe for users and the environment. In this case, certain conditions are met: a) it is necessary to use compressed 100% CO2 in cylinders supplied with a given displacement rate (from 10% to 70% of the chamber volume per minute); b) between use the chambers must be purified of CO2; c) before stopping the supply of CO2, the investigator must visually verify that the animal has died; d) CO2 flow rate can be increased after animals lose consciousness in order to hasten death. [ABSTRACT FROM AUTHOR]

Today, in the Republic of Kazakhstan, molecular genetic studies of central nervous system (CNS) tumors are an urgent and very interesting problem that arose in 2016 after the introduction of the updated classification by the World Health Organization (WHO). In the new era of molecular genetic research, there have been significant changes in the pathohistological diagnosis of glial and embryonic tumors. In this regard, molecular genetic studies of CNS tumors have certainly become one of the most important research methods in the process of making a clinical diagnosis of neuro-oncological patients. [ABSTRACT FROM AUTHOR]

The article is devoted to the results of studies of the antiparkinsonian activity of harmine hydrochloride by the International Research and Production Holding “Phytochemistry”, as well as to studies of betacarboline derivatives, which we present in this article in the form of a literature review. The article is devoted to the results of pharmacological studies of harmine hydrochloride. According to the results of acute and chronic toxicity, it was determined that harmine hydrochloride belongs to the category of moderately toxic substances (hazard class II), does not cause pathological changes in the general condition of animals, does not have an allergenic, carcinogenic and mutagenic effect, does not have immunotoxicity and reproductive toxicity. Based on the results of molecular docking, the presence of strong bonds in harmine hydrochloride with monoamine oxidases A and B was revealed, which indicates the implementation of the mechanism of the antidepressant action of the alkaloid at the level of synoptic neurotransmission. Determination of the relative bioavailability of harmine hydrochloride in experimental animals showed that harmine hydrochloride is absorbed much faster when administered orally, quickly reaches the highest concentration in blood plasma. The antiparkinsonian, antidepressant, antihypoxic activity of harmine hydrochloride was studied. It was found that harmine hydrochloride eliminates haloperidol-induced catalepsy in rats, reduces oligokinesia and rigidity in the Parkinson’s test, and has antihypoxic activity in the hypobaric hypoxia test. In the experiment of psychopharmacological tests «closed cruciform labyrinth» and «slippery funnel», harmine hydrochloride showed a psychotropic effect of a stimulating type, while a relatively high activity was revealed in terms of indicators characterizing the effect on motor activity, which indicates its antidepressant activity. The results of biochemical studies indicate a decrease in the level of cortisol when modeling stress-induced disorder in experimental animals. [ABSTRACT FROM AUTHOR]

The article provides a review of the scientific literature on the topic of implants used in the field of neurosurgery for plasty or reconstruction of the dura mater, in particular for head injuries, decompressive craniectomy, meningial tumors of the brain, and intraoperative defects. The article provides information not only about existing implants, but also current research ongoing studies in this area, as well as methods for manufacturing implants. [ABSTRACT FROM AUTHOR]

Background. The association of chronic inflammation and oncogenesis is well known to explain the increased interest to get cheap and informative inflammatory markers, such as neutrophil / lymphocyte ratio (NLR), red cell distribution width (RDW), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Objective. The aim of this study is to evaluate the prognostic value of a wide panel of inflammatory factors in patients with brain gliomas. Methods. 190 patients with brain gliomas surgically treated in 2013-2016 at the Department of Pathology of the CNS of National Centre for Neurosurgery (Astana, Kazakhstan) were included in the study. Statistical analyses were performed using the STATISTICA 7.0 statistical software package (StatSoft, Inc., USA, Tulsa, OK). Results. A significant association with overall survival was found for the following indicators (nonparametric Mann-Whitney test): ESR (p=0.007); NLR (p=0.004); RDW (p=0.03); leukocytes (p=0.04) and albumin (p=0.02); CRP / albumin ratio (CAR, p=0.05); age (p=0.0002); Karnofsky performance score (KPS, p <0.0001) and malignancy of the tumor (G, p <0.0001). Аge, KPS and G (p <0.0001) were left after stepwise exclusion of the least informative variables in discriminant analysis of the studied parameters to survival. Conclusions. This study showed a significant association of several inflammatory parameters (NLR, RDW, ESR, leukocyte and albumin levels, CAR) with survival; in addition, we note that the predictive value of CAR, to our knowledge, was not previously shown in such patients. At the same time age, gender, G and KPS were the most powerful factors of the prediction. Further research with the patient’s group extension will allow us to advance in the search for new significant markers and therapeutic approaches. [ABSTRACT FROM AUTHOR]

In this article, we conducted a literature review of articles on vestibular schwannomas, the development of its complications after microsurgical removal in the form of herpetic lesions. It includes data on the ways that herpes viruses can affect the human body, also about the presence of the virus in the tissues of the vestibular schwannomas and reactivation of herpes viruses after the surgery, which can cause neurological deficiencies such as facial nerve paresis and the appearance of herpetic eruptions along the innervated trigeminal, facial nerve. [ABSTRACT FROM AUTHOR]

This article describes 5 cases of myelopathy treatment by using laminoplasty as the method of decompression in the JSC “National Center of Neurosurgery”. The patients were operated by the method of laminoplasty unilateral open door from October 2017 to February 2018. Results were evaluated in post op period and after 3 months follow up through the scale of the Japanese Orthopedic Association (JOA) scale and determine the degree of severity of cervical myelopathy and radiculopathy Nurick, MRI and CT imaging. All patients showed improvement that was described as a regression of myelopathic syndrome. [ABSTRACT FROM AUTHOR]

Simulation training in medicine is a relatively new trend that actively developed in the last few years. In addition, this very importance of simulation technologies in the training of neurosurgeons both in the field of scientific knowledge and in the practical specialty is beyond doubt. Nevertheless, this article reviews the wishes of young specialists, as well as the opinion of leading clinics in employment recruitment, where the requirements for specialists’ skills and knowledge are growing. In this connection in modern time, introduction of simulation technologies seems to be especially useful and has significant potential for further development in training of specialists. [ABSTRACT FROM AUTHOR]

Purpose of the study. To determine the criteria for the assessment of acute small subdural hematomas for the subsequent treatment of intracranial subdural hematomas of small volume. Methods. A retrospective analysis was carried out, as well as an assessment according to the criteria of a unified scale of 210 patients from March 2018 to December 2020 in the Department of Emergency Neurosurgery of LLP “CRH” in Nur-Sultan with acute small subdural hematomas, including patients with indications for a certain type of surgery. Results. In 123 patients, after conservative treatment, according to CT of the brain, complete resorption of the hematoma was observed within up to 10 days. In 63 cases, it was possible to transform an acute hematoma into a chronic form and subsequently apply minimally invasive tactics (closed external drainage of the hematoma). 29 patients, due to the negative dynamics on the background of drug treatment, underwent osteoplastic trepanation (KPT) with the removal of the hematoma within 3-4 days. Based on the data, a unified scale was developed, which sets out the criteria for determining the tactics of treatment “Scale for assessing hematomas of acute small subdural hematomas” (SOMH). Conclusion. A unified scale is presented for determining the tactics of treating acute subdural hematomas of small volume, based on clinical and expectant management, which allows expanding the indications for minimally invasive treatment or refusal of surgical treatment to complete resorption of the hematoma based on an in-depth understanding of the pathogenesis of subdural hematomas. [ABSTRACT FROM AUTHOR]

Caring for patients with brain tumors is a multiple process and attention must be paid to every aspect of neurosurgical care in the pre and postoperative period, helping to minimize any potential problems that could delay their treatment. There are many complications of varying severity that can occur at any stage of a patient's treatment. These complications can affect the time of the expected operation, recovery process immediately after surgery, and adversely affect adjuvant and concomitant treatment in oncological processes, sometimes causing the need to delay their use in case of complications such as wound infections. An analysis of the treatment of patients from January 1, 2018 to September 2020 of the Central Nervous System Pathology Department of the JSC “National Center for Neurosurgery” was carried out, and this article offers recommendations for patient care. The experience of the Central Nervous System Pathology Department over the past 12 years has formed the rules for the management of patients, which allow minimizing the risk of infection, both before and after surgery, and identifying surgical complications at an early stage. [ABSTRACT FROM AUTHOR]

Purpose of the study. Evaluation of the results of treatment of neurogenic dysfunction of the pelvic organs by the method of sacral nerve stimulation. Methods. Implantation of a permanent sacral nerve stimulator was performed to 79 patients of the department of vascular and functional neurosurgery of the JSC “National Centre for Neurosurgery” in NurSultan for nerve stimulation of the 3rd sacral nerve plexus in the treatment of neurogenic dysfunction of the pelvic organs resulting from various lesions of the nervous system from December 2013 to December 2019. Sacral nerve stimulation was carried out from the early postoperative period with monophasic electric impulses, rectangular shape, 210-220 ms duration, with a frequency of 5-25 Hz and an electric current amplitude of 0.3 to 5.0 W. The study included patients over 18 years of age with a confirmed diagnosis. The average age of the patients was 40 years, range from 18 to 64 years, 51 men and 28 women. In 47 of them, the causes of neurogenic dysfunction of the pelvic organs were due to pathology of the spinal cord, in 29 patients the causes of this pathology due to brain damage and 3 patients due to damage to the peripheral nervous system. The criteria for evaluating the effectiveness of the treatment were the improvement of the parameters of a complex urodynamic study (CUDS) in neurosurgical patients with neurogenic dysfunction of the pelvic organs. Results. Тhe results of treatment of patients in the main group (n = 79) showed high efficiency. In the early and late period of constant nerve stimulation of the sacral plexus, an improvement in the parameters of the evacuation function of the urinary bladder was found in the form of a gradual complete and/or partial recovery of spontaneous urination and a decrease in the total amount of residual urine, which was observed in 58% of patients, an improvement in the parameters of the reservoir function of the bladder, a decrease in and/or relief of urinary incontinence was observed in 42% of patients, relief of urinary and fecal incontinence and pain in 22% and 17%, respectively. Against the background of specific complex therapy, in the early period of nerve stimulation, a decrease in the frequency of the recurrent course of pyelonephritis was determined in 36% of patients, and in the late period of nerve stimulation in 47%, respectively, complete relief of the phenomenon of hydronephrosis in the late period is observed in 62% of patients, based on the restoration of an adequate passage urine from the upper and lower urinary tract in patients after implantation of a permanent sacral nerve stimulator in the late period, in a hospital setting, removal of permanent urinary drains was performed in 33% of patients. Conclusion. Sacral nerve stimulation is a highly effective method of treating patients with severe forms of dysfunction of the pelvic organs. Sacral nerve stimulation is an alternative and often the only possible method of treating patients with neurogenic pelvic dysfunctions. [ABSTRACT FROM AUTHOR]

In this article, the authors analyzed literature sources, describing the best tactics of transfusion therapy and domestic regulations. The results of randomized clinical trials of the last decade, testifying the advantages of restrictive tactics of transfusion therapy, have influenced a more rigorous record of indications for transfusions of blood components. The trend in the world of modern transfusiology is restrictive tactics of prescribing blood components - only by indication, only in a situation where the clinical prognosis worsens without transfusion. Blood saving technologies can effectively control and correct hemostasis, reduce the transfusion load and associated risks, and provide an increase in the amount of high-tech care. [ABSTRACT FROM AUTHOR]

Despite of advances in neurosurgery and chemoradiotherapy in recent decades, as well as significant improvements in understanding the biology and genetics of tumors, the prognosis for patients with malignant gliomas remains poor. Previous studies have shown that totally remove of the tumor was achieved in less than 20-30% of patients. 5-aminolevulinic acid (5-ALA) is a drug that leads to accumulation of fluorescent protoporphyrins in malignant glial cells. The fluorescence can be visualized intraoperatively by use of a modified microscope. The JSC "National Center of Neurosurgery" (NCN), the Department of Pathology of the central nervous system (PCNS), the first in Kazakhstan began to use fluorescent intraoperative navigation. We present the results of 9 cases treated. Material and methods: In cases with suspected malignant glioma was performed microsurgical removal of tumors with fluorescence. Two hours before surgery, patients received 5-ALA (Gliolan). All patients had a postoperative computer tomography or cerebral magnetic resonance imaging scan done within 72 hours to evaluate residual tumor volume. Results: 9 patients with malignant gliomas underwent microsurgical removal of tumors with fluorescence. Maximum and total resection was achieved in 7 cases (77.8%), subtotal resection in 2 cases (22.2%). Conclusion: The intraoperative navigation fluorescence increases total removal of high grade glial brain tumors. However, the number of cases does not allow a comparative analysis with other studies. [ABSTRACT FROM AUTHOR]

Introduction. Biobank is a large-scale biomedical database and an important research resource for conducting scientific, translational, clinical research aimed at developing new treatment methods in modern medicine. Materials and methods. Biological materials (tumour, venous blood) from patients with glial tumours were selected for the study. Biomaterials were processed and cryopreserved in a biobank. Histological, immunohistochemical and molecular genetic studies were performed to establish the diagnosis. All information about the biosamples was recorded in an electronic biobank database. Results: For three years of research (from 2018 to 2021), 777 aliquots from 269 patients were collected in the biobank of the National Centre for Neurosurgery. These are patients mainly with glial tumor lesions of the brain of the III-IV degree of malignancy. All clinical and pathomorphological results of patients are stored in an electronic information system. Conclusion: This biobank will allow us to search for new methods of treatment, improve the quality and increase the life expectancy of neurosurgical patients in the Republic of Kazakhstan. To attract investment from both domestic and foreign investors in the development of scientific research, which together with the above will contribute to the positive development of the country’s economy. The article was prepared within the state order for scientific programme realization under the budget programme 217 «Development of science», subprogram 101 «Programmed target-oriented financing of scientific and/or scientific-technical activity subjects at the expense of the republican budget», subject: BR10965225 «Development of molecular-cytogenetic research programme and creation of biobank of central nervous system tumours». [ABSTRACT FROM AUTHOR]

In this article, we provided a literary review of articles on the diagnosis and treatment of brain glioblastomas, maximum of surgical resection, the importance of pathogenetic mechanisms, types of combined treatment, optimal period of radiation therapy and average survival. [ABSTRACT FROM AUTHOR]

The diagnosis of pituitary adenoma (PA) often made in the later stages of the onset of the disease, which complicates the treatment of the disease. Surgical intervention is the main treatment for acromegaly, and the best method of initial therapy is transnasal transsphenoidal endoscopic removal of the tumor, as it provides a more rapid decrease in the level of growth hormone (STH), decompression of the nerve structures (chiasm), and improves the effectiveness of drug therapy with somatostatin analogues. It must be borne in mind that only 25% of somatotropinomas does not extend beyond the sella turcica, which presents certain technical difficulties during the operation. Even in specialized clinics with experienced neurosurgeons, the proportion of patients who achieved biochemical control of acromegaly after a single operation does not exceed 50%. Somatostatin analogs are highly effective in drug treatment of acromegaly. In the presented clinical case, 3 months after the operation against the background of treatment with Sandostatin-LAR (long-term somatostatin) at a dose of 20 mg, a high level of insulin-like growth factor-1 (IGF1) was observed in the patient’s blood at a normal level of STH. But taking into account that the therapeutic effect of the drug treatment with somatostatin analogues occurs within 3-12 months, the drug treatment is continued, but titration of the drug dose is recommended. Also, to analyze the quality of life of the patient in the postoperative period, we first experienced use of the Acromegaly Quality of Life Questionnaire (AcroQoL) to assess the quality of life of patients with acromegaly. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage (hemorrhagic stroke) is a cerebral hemorrhage caused by the rupture of blood vessels in the brain parenchyma. Given the high mortality and possible severe consequences of hemorrhagic stroke, it is important to explore various methods of its treatment. Cases of brain hematomas resulting from intracerebral hemorrhage in functionally significant areas of the brain that are difficult to access for surgery require alternative methods of its removal. The article presents a clinical case of hematoma removal in the thalamus region by stereotactic aspiration in a 49-year-old patient. Stereotactic aspiration was performed by, fixing the stereotactic frame to the patient’s head, establishing the coordinates and trajectory of the needle from the entry point to the hematoma, and further puncture and aspiration of the hematoma. As a result of the operation, positive dynamics were observed during the rehabilitation period, which corresponds to an improvement in the patient’s condition on the Barthel index of 20 points at the time of admission and 50 points at the time of discharge. In conclusion, it was found that further study of stereotactic hematoma aspiration as a potential alternative treatment for hemorrhagic stroke is necessary. [ABSTRACT FROM AUTHOR]

Introduction. Craniopharyngioma is a tumor of the cellar and suprasellar region, which originates from the embryonic remains of a Ratke pocket that connects the cavity of the primary oral tube with the pituitary gland in the embryonic period, with a frequency of 0.13 per 100 thousand patients. These tumors are classified as histologically benign tumors, but patients with craniopharyngiomas have high disability and mortality, most often associated with hypopituitarism. Objective. To analyse the effectiveness of a multidisciplinary approach to the treatment of craniopharyngiomas complicated by diabetes insipidus. Materials and methods. The results of surgical and medical treatment of craniopharyngioma, complicated by diabetes insipidus based on instrumental and laboratory studies. Results. In the preoperative period, the patient demonstrates signs of diabetes insipidus. After surgery, endocrine disorders worsened and hemodynamic disturbances were added. Adequate replacement therapy with the participation of endocrinologist allowed to restore hormonal, water-electrolyte and hemodynamic balance. Conclusion. Only with the right surgical strategy and timely replacement therapy it can be possible to achieve complete regression of hemodynamic disorders and to restore hormonal levels and water-electrolyte balance. [ABSTRACT FROM AUTHOR]

The paper presents the results of quality of life (QOL) assessment in patients with tumors of the cranioorbital localization who were hospitalized and operated in the department of central nervous system pathology of «National Centre for Neurosurgery» JSC, Nur-Sultan from January 2016 to September 2018. [ABSTRACT FROM AUTHOR]

The paper discusses the formation and functional characteristics of hemostasis in children, as well as the effect of brain tumors on the hemostatic potential of blood. Shifts in coagulation hemostasis in children are physiological and, as a rule, do not have a significant effect on the hemostatic potential of the blood, but they can easily transform into coagulopathy. Decompensation develops more easily, the lower the child’s age, this is due both to the peculiarities of the hemostasis system itself and to the immaturity of the central regulatory mechanisms. And used in the treatment process glucocorticoids tend to reduce the levels of procoagulant factors. The main cause of coagulopathy is the entry into the bloodstream of plasminogen activator factors from tumor cells or tissue factors from the damaged brain parenchyma during surgery. The use of thromboelastography in monitoring the coagulation of pediatric neurosurgical patients helps to identify patients with an increased risk of bleeding or thromboembolic complications and effectively treat them. [ABSTRACT FROM AUTHOR]

Introduction. The World Health Organization gave the following definition: Quality of life (QoL) is the perception of individuals of their status in life in the context of the culture and values of the environment in which they live, according to their goals, expectations, standards and concerns. Quality of life includes information on the major area of life: psychological, physical, social, economic, spiritual, which allows determining the differential impact of the disease and treatment on the patient's condition. Objective. Adaptation and implementation of the quality of life questionnaire EORTC QLQ-C30 and QLQ-BN20 in neurosurgical practice in the Republic of Kazakhstan. Materials and methods. The pilot testing of EORTC QLQ-C30 and QLQ-BN20 questionnaires was conducted on the basis of the Department of central nervous system pathology of the "National Centre for Neurosurgery" in patients with malignant tumors of the central nervous system. Results. Implemented and adapted to the official version of the questionnaire EORTC QLQ-C30 and QLQ- BN20 in the Kazakh language in practical neurosurgical operations in Kazakhstan. Conclusion. The versions of these questionnaires can be used in domestic cohort studies and clinical practice in the Republic of Kazakhstan. The use of these tools of assessing the quality of life will help professionals in the planning of individual treatment strategies and the selection of the necessary therapy. Thus, the approved version of the questionnaires in Kazakh language is now available for mainstream use on the official website EORTC.com. [ABSTRACT FROM AUTHOR]

Objective. Cancerous form of teratoma has characteristics of metastasis by lymphatic and blood vessels and also distribution by flow of spinal fluid. Here is a case of immature teratoma of pineal region with metastasis into right fronto-temporal region. Materials and methods. Patient (man) of 18 years old underwent an operation of microsurgical oncotomy in pineal region with infratentorial supracerebular access. Six months after X-ray therapy there was a metastasis of immature teratoma identified during MRT in the right fronto-temporal region of the brain. Conclusion. Patients that underwent operation oncotomy of both mature and immature teratomes in pineal region with the purpose of prevention from metastasis require regular control and routine examination of brain with MRT even after full remission of oncoma. [ABSTRACT FROM AUTHOR]