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Aim of the study to examine the risk factors for carotid endarterectomy (CEA) and their effect on the results of surgical treatment in patients with chronic cerebral ischemia. The study included 340 patients who were operated in the institute from 2007 to 2011. All patients underwent CEA in various modifications. Based on the classification of surgical risk CEA proposed by Sundt, patients were divided into 4 groups. In the following analysis, we evaluated perioperative outcomes of surgical treatment in the third and fourth groups, respectively, compared the frequency of the installation of temporary intraluminal shunt (TIS) during the surgery, depending on the severity of angiographic risk factors and neurological anamnesis. Perioperative ischemic complications in the third group was 4.2%, 6.4% in the fourth respectively. In both groups, TIS required in 15% of operations. In patients undergoing surgery under regional anesthesia, shunts were used two times less frequently than in patients under general anesthesia (8.8% vs. 19.8%). Correlation between the severity of angiographic risk factors and tolerance to hypoperfusion of the brain, caused by a temporary clamping of the ICA revealed. In case occlusion of the contralateral ICA temporary shunts have been installed in 40%, with contralateral stenosis in 15% and without angiographic and risk factors in 80% of cases. The findings coincide with the results of similar studies published in the literature. Taking into account our and foreign data should be noted that CEA in patients with high surgical risk by Sundt is accompanied by an increased incidence of perioperative ischemic complications and requires more differentiated approach to the tactics of surgical treatment, and choice of the method of neurophysiological monitoring during surgery.

46 year old man appealed to the Cancer Research Center of RAMS in October 2012 with unverified anterior superior mediastinal tumor, which was diagnosed in 2010. Progressive compartment syndrome of the superior vena cava was observed. On examination: CT, MRI, angiography, histological and cytological examination of biopsy material did not allow to confirm the morphological structure of the tumor. Removal of the tumor with bifurcation of the brachiocephalic trunk prosthetics was performed. Immunohistochemical (IHC) study verified malignant hemangioendothelioma.

Among anesthetic agents used in neurosurgery xenon appears to be the most advantageous. It preserves arterial blood pressure, assures rapid recovery and neuroprotection. But the data is lacking on xenon effect upon cerebral blood flow under anesthetic conditions. We measured flow velocity in middle cerebral artery in neurosurgical patients without intracranial hypertension during closed circuit xenon anesthesia comparing propofol and xenon effect in the same patients. In our study xenon didn't seem to induce clinically relevant changes in cerebral blood flow and preserved cerebral vascular reactivity thus proving its safety in patients without intracranial hypertension.

The paper contains information about surgical occlusion of the common carotid arteries--one of the causes of chronic cerebrovascular ischemia. For the period from 2003 to the present time have been treated 25 patients with a clinical picture of cerebral ischemia due to occlusion of the common carotid artery. Performed a total of 48 surgical procedures among which subclavian-external carotid and common carotid bypasses, retrograde carotid thromboendarterectomy. In 7 cases revascularization of the brain was performed as a second stage. Choice of reconstruction type based on preoperative investigation results and intraoperative data. No persistent complications or mortality were observed. Positive clinical dynamics was noted in 80% of cases. Crossability of reconstruction area at the annual catamnesis was 84%. Prosthetic vascular graft thrombosis occurred most often (up to 40%) in patients with type 2 occlusion and in the presence of severe collateral perfusion. In patients with 1st type of occlusion of the common carotid artery reconstructive surgery have shown to be a reliable and effective treatment for chronic cerebral ischemia and prevention of recurrent ischemic stroke.

Authors studied cognitive functions in 97 patients with different clinical presentations, lateralization and number of stenotic brachio-cephalic vessels. The Luria's syndrome neuropsychological analysis distinctly revealed the topics of cognitive deficits. Wechsler verbal memory tests, the Stroop test (words-figures), the Schulte test were administered as well. Disturbances of high psychic functions were found in 97.9% of patients. The bilateral pathology of lobe regions was noted most often. The dysfunction of parietal and temporal lobes was mainly unilateral and was linked with the side of stenosing process. Disturbances of neurodynamic parameters of mental activity were correlated with the age (higher frequency in patients older than 50 years), a side of stenosis and/or lesion of stroke, bilateral lesions of carotid arteries. The results allow a more precise assessment of clinical significance of carotid stenosis in the development of cognitive dysfunction that may assist in recommendation of surgical treatment.

Authors conducted a clinical-instrumental examination of 97 patients in the post-operative phase of reconstructive surgery of carotid arteries. Evaluation of neurological status, Luria's syndrome neuropsychological analysis for assessment of higher mental functions dynamics (HMF) were carried out. Pre-operative ultrasound duplex scanning of brachio-cephalic arteries and investigation of cerebral perfusion using spiral computed tomography (SCT-perfusion) were done before and 1 day after the surgery. The frequency of intrasurgery stroke in the area of the operated carotid artery was 2.1%. Pre-operative SCT-perfusion revealed the syndrome of cerebral hyperperfusion in 3.1% of patients with higher (1 s) difference between the average time of blood transition in temporal areas. Dynamics of HMF was the key clinical indicator that allowed to evaluate the course of nearest post-operative phase and to compare it with an area of operated vessel. Changes of HMF were characterized by the decrease in dysfunction of the hemisphere ipsilateral to the side of operation or had differently directed character. The aggravation of HMF disturbances was found in 40% of patients and was represented by syndromes with different topical location. Causes and mechanisms of the development of these changes are discussed.

The aim of this study was to assess the role of different modalities in early diagnosis of cerebral hyperperfusion syndrome (CHPS) following carotid endarterectomy, as well as to develop effective treatment protocol for abovementioned complication.Study group consisted of 61 patient who underwent uni- or bilateral carotid endarterectomy (CEA). Diagnostic modalities included transcranial Doppler study (TCD), cerebral oximetry, perfusion CT scanning and neuropsychological evaluation.We demonstrated that both bilateral carotid stenosis and stroke were independent predictive factors for CHPS at early postoperative period. "Classical" two-fold increase of cerebral blood flow in ipsilateral CMA was seen in 15% patients only. According to our data, predictive TCD-value was 1.48 increase of CBF. The most informative tool for early CHPS diagnosis was perfusion CT scans: preoperative mean transit time asymmetry in temporal areas (in the group of patients with unilateral carotid stenosis) correlated with CHPS development. Effective medical treatment for CHPS was achieved with Ca2+ channel antagonists use, that enabled us to prevent evolution of "mild" clinical appearance of CHPS into status epilepticus or intracerebral hemorrhage.Modern diagnostic modalities that assess brain perfusion can (with certain rate of accuracy) predict CHPS development even preoperatively. Early therapy of this complication with Ca2+ antagonists can usually control it.

Range of methods for diagnostics of extracranial arterial stenosis includes both untrasonic techniques (transcranial Doppler study, duplex sonography, which are not only screening methods, but also used in surgery as well) and high-tech imaging methods--spiral CT scans and MR angiography with visualization of structural changes in vascular wall, quantitative and functional assessment of blood flow in vessels. Aim of this study was to determine the effective of non-invasive diagnostic techniques--MR angiography (MRA), including phase-contrast MRA (PCMRA), and spiral CT angiography (SCTA) in identification and comprehensive assessment of stenosis of internal carotid artery and comparison of capabilities of these methods with gold standard--direct angiography.

Today there are prospects for the wide use of xenon for anesthesia or analgesic sedation in neurosurgical patients, but clinical trials of and experience in using the agent in neurosurgery are scanty. The paper reports the first case of acute intracranial hypertension during xenon anesthesia in a patient with a giant brain base tumor and cerebrospinal fluid flow obstruction in the presence of subcompensated intracranial hypertension. Comparison of intracranial pressure, blood pressure, cerebral perfusion pressure, and linear blood flow velocity suggests the nature of the effect of xenon on cerebral vascular tone, cerebral blood flow, and its autoregulation. Based on the findings, the authors discuss whether xenon may be used in patients with intracranial hypertension.

Twenty-nine patients with basilar artery aneurysms were operated on using one of three approaches: pterional, orbitozygomatical, and subtemporal. The efficiency of surgery and the frequency of surgical complications are analyzed in detail in relation to the data of an angiographic study and the intraoperative pattern. Three (10.3%) patients died in the postoperative period. In most cases, the pterional approach is adequate for clipping almost any aneurysm of the distal portions of the basilar artery; the use of the orbitozygomatical approach in patients with aneurysm of the same location is determined by its extent and/or adhesions with the adjacent brain structures. Current neuroimaging techniques are of the most informative value in choosing a surgical treatment policy in each specific case.

An investigation of the state of volumes of the organism's fluid sectors (general, extra- and intracellular fluid) by a noninvasive method of double-frequency impedancemetry has revealed the influence of preoperative preparing the patients and restriction of the water regimen after operation upon the development of moderate dehydration of the extracellular sector. During the operation lasting about an hour the intravenous administration of 400 ml of crystalloid solutions maintains the volumes of fluid sectors within the due values. These solutions injected in greater volumes result in accumulation of the extra- and intracellular fluid. The antiperistaltic purgation of the intestine before the operation reduces the concentration of calcium in blood by 1 mmol/l at an average.