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Despite difficulties in providing xenon anaesthesia, xenon still seems to be attractive for neurosurgical procedures. But data upon its effect on intracranial (ICP) and cerebral perfusion pressure (CPP) remains controversial. We monitored ICP and CPP in patients with or without intracranial hypertension during xenon inhalation in different concentrations. Our results suggest that caution should be used while inhaling xenon in high anaesthetic concentration in patients wiith known intracranial hypertension. We also address new possibilities of xenon use, e.g., for sedation in neurosurgery. The study was supported by Russian Fund for Fundamental Research, grant number 13-04-01640.

Glioneuronal tumor with neuropil-like islands - GTNI is a rare histopatological subtype of anaplastic astrocytoma. English-language literature contains only 43 observations, among them only 4 observations in children up to 18 years. Neuropil is an eosinophilic stained a cellular foci of tumor tissue. These cells demonstrate less proliferation activity than prevailing glial component, which is characterized by a high degree of atypia - Gr III according to WHO classification. Single reports about verification of the glioneuronal tumor with neuropil-like islands in children are supplemented with an observation of the case with tumor, located in lateral ventricular in infant with the onset of hypertension symptoms at the age of 11 months. The potential for complete removal of these tumors despite its large size and young age of the child is presented. However, the prognosis in infants with GTNI despite completeness of removal and chemotherapy might be extremely unfavorable - in case of intraventricular localization progression in the form of tumor implantation on ventricular ependyma is possible.

Desflurane (Des)--is a modern inhalation anaesthetic available in Russia since August, 2013. Des is a halogenated ether; its chemical structure is 2-difluoromethoxy-1-1-1-2-tetrafluoroethane (C3H2F6O). Special thermocompensated evaporators are used for Des dosing. Low solubility in blood and tissues of an organism causes fast absorption and elimination of Des. Blood/gas distribution ratio of Des is 0.42. Des distinctive properties are high saturated vapor pressure, super short duration of action and average power. Furthermore it is characterized by the minimal metabolism and lack of interaction with soda lime. Des is used for general anesthesia in a cardiac surgery neurosurgery, out-patient surgery, pediatric practice and other areas of surgery. Des has more positive qualities and fewer limitations, than other inhalation anaesthetics (halothane, isoflurane, sevoflurane). High cost of the anaesthetic is compensated by quality and controllability of anaesthesia and reduction of stay time in recovery unit. Fast elimination of the anaesthetic from a body allows reducing a frequency of complications connected with violation of upper airway and hypoxemia, promotes early discontinuation of artificial ventilation, reducing somnolence, earlier restoring a muscular tone in the postoperative period.

Recently vascular neurosurgery is on stage of comparing of different techniques for intracranial aneurisms treatment. Clinical and randomized studies provide with data that different drugs and techniques have neuroprotective effect, for example haemogenesis growth factors. To introduce any growth factors in practice the research proving the effectiveness of the drug must be carried out. Accurate and complete characteristics of treatment outcomes play the main role in all studies. Terms of outcomes assessment must be characterized and patients must be distributed in order of their condition. The article briefly reviews the problem of comparative assessment of different techniques for intracranial aneurisms treatment.

Cerebral vasospasm is a major cause of cerebral ischemia and neurological deficits in patients after SAH from the aneurysm. According to angiorraphy cerebral vasospasm in acute rupture of an aneurysm is detected in 50-70% of cases, and the risk of ischemia on it's background is 19-46%. One of the new trends of treatment of cerebral vasospasm is the intra-arterial injection of calcium channel blockers. The article presents a case of selective intra-arterial injection of verapamil for the treatment of cerebral vasospasm in patient after severe subarachnoid and parenchymal hemorrhage of the internal carotid artery bifurcation aneurysm with a good clinical outcome.

Functional immaturity of all organs and systems result in a high risk of complications in surgery of brain tumors in infants. One of the most serious complications is a massive blood loss and developing on its background severe disorders of hemostasis. In modern series of observations perioperative mortality in these children varies from 13 to 33%. The purpose of this paper--based on an analysis of topography, morphology and features of the operations to determine risk groups of blood loss in surgery of brain tumors in infants and suggest the best options for surgical tactics. When operating blood loss exceed 300% of the calculated blood volume persistent violations of coagulation homeostasis develop, which can lead to uncontrolled bleeding and death on the operating table, or post-operative bleeding. Intraoperative blood loss could be reduced by surgical techniques improvement, as well as by improving of anesthesia. First type includes preoperative embolization of the afferent vessels, careful planning of surgical approach, including using neuronavigation, deep stromal tumor coagulation during debulking, primary coagulation of main feeding blood vessels, two-stage surgery, and optimization of speed of tumor removal. All these methods has reduced the overall operational and post-operative mortality rate from 13 to 5%.

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.

Efficacy and safety of microvascular decompression of trigeminal nerve depending on the position on the operating table were assessed in 200 neurosurgical patients in retrospective observational study It was shown that efficacy doesn't depend on positioning. Lying position eliminates probability of such complications as postural hypotension, hypotension during surgery, tension pneumocephalus and peripheral nerves injury. Sitting position increases risk of air venous embolism by 25 times. Lying position increases risk of postoperative nasal liquorrhea by 4 times, but eliminates risk of postoperative paresis of trigeminal nerve. It is also decreases risk of corneal reflex reduction by 3 times, hyperpathia by 2 times and paresthesias by 5 times, but increases probability of postoperative hyperesthesia by 4 times. Microvascular decompression of trigeminal nerve in lying position is safer than similar operation in sitting position.

Patients with coronary artery stents are extremely dependent on antiplatelet therapy whose discontinuation may lead to stent thrombosis with major cardiac adverse events. In neurosurgery chronic antiplatelet medications uptake is supposed to be the major factor of postoperative intracranial hematoma associated with poor outcome and high mortality. Thus planning neurosurgical procedure in patients with coronary stents needs a thorough evaluation of all risk factors pondering possible profit and danger. We discuss current recommendations on perioperative management for high risk bleeding surgery in high risk thrombosis patients emphasizing the role of individual approach and multidisciplinary collaboration.

In a review paper, an analysis of publications in the world literature on the problem of acute postoperative pain in neurosurgical patients who underwent craniotomy is performed. Is shown that problem of acute postoperative pain in patients after craniotomy was underestimated for a long time. Mistakenly was thought that these patients do not experience any pain in the early postoperative period. Results of recent studies have shown that up to 80% of these patients may experience acute pain in the range from mild to severe. Unarrested postoperative pain could cause a number of serious secondary complications. This article demonstrates basic approaches to the prevention and treatment of acute postoperative pain in neurosurgical patients after craniotomy--first of all, the use of narcotic analgesics, NSAIDs, and other approaches.

The article presents the description of clinical observation, in which spinal neurosurgical intervention was successfully made in a patient with ESRD, receiving chronic hemodialysis for 20 years. In this context, we discuss the various clinical and tactical aspects of the management of patients with this severe co-pathology: infusion-transfussion therapy, peculiarities of anesthetic management and intra-operation monitoring, diagnostics and correction of hemostasis disorders, hemodialysis organization.

Robotized system for radiosurgery CyberKnife (Accuray Inc., USA) is the first device dedicated and optimized for advanced irradiation during 1-7 fractions (i.e. radiosurgery and hypofractionation). CyberKnife is characterized by elaborate guidance system, high precision of dose delivery, possibility of conformal dose distributions with high gradient of target borderline dose which is most important in proximity of critical structures. The first CyberKnife system in Russia was installed in Burdenko Neurosurgery Institute. The paper presents 2-year experience of treating patients using CyberKnife. From April 2009 till October 2011 896 patients were treated using CyberKnife. Mean age was 48 years. Overall number of sessions was 2626. Radiosurgical procedures were performed in 21.8% of patients. 91% of cases were treated for intracranial lesions. Limited follow-up period in all kinds of pathology demonstrated results consistent with standard fractionation or radiosurgery. The rates of observed complications were also comparable with accepted techniques. CyberKnife system plays significant role in everyday activity of department of radiation therapy. In careful and thorough selection of patients it allows efficient and high-quality treatment of patients with neurosurgical diseases.

Xenon assures rapid awakening and stable hemodynamics, it also has some neuroprotective effect. This is the reason why it may become an anesthetic of choice in neurosurgery. Still there is little and controversial data on its impact upon ICP. This is the first study of xenon effect upon intracranial pressure, cerebral perfusion pressure and cerebrovascular reactivity during xenon anesthesia in neurosurgical patients without intracranial hypertension. We report a slight increase in intracranial and a slight decrease in cerebral perfusion pressure during xenon anesthesia and show that cerebrovascular reactivity is preserved. Thus we conclude that xenon anesthesia is safe for neurosurgical patients without intracranial hypertension.

The hemostasis state was assessed by routine tests and TEG in 169 patients on long term aspirin therapy. According to TEG results all the patients were divided into three groups: normo-, hypo- and hypercoagulation. The aspirin therapy was interrupted in normo- and hypercoagulation groups, but the surgery was not postponed. In cases of hypocoagulation the aspirin therapy was also interrupted and the surgery was postponed for 3-5 days until TEG results normalized. Also the frequency of intracranial hemorrhagic complications was analyzed in every group. The results showed that despite the method used the hypocoagulation group had the highest rate of postoperative hemorrhage complications. Thromboelastography enables to assess hemostasis state in neurosurgical patients on long term aspirin therapy promptly and effectively.

In recent years the background for xenon anesthesia implementation in neurosurgery has been created. A variety of researches have been conducted though very few of them concerned xenon effect upon cerebral metabolism. We assessed cerebral oxygenation and cerebral metabolism during propofol anesthesia followed by xenon closed circuit anesthesia in neurosurgical patients. Xenon inhalation was marked by higher jugular vein saturation, oxygen content and glucose level and lower arterio-venous difference. We conclude that compared to propofol xenon improves cerebral oxygenation and decreases cerebral metabolism in neurosurgical patients.

The study reports the results of monitoring the depth of anesthesia with BIS technology in 456 neurosurgical patients with different neurosurgical pathology: sub- and supratentorial tumors, aneurisms, arteriovenous malformations, spinal pathology, etc. BIS reflects hypnotic state of the brain during anesthesia in almost all the cases, except for bifon-tal surgical approach when sensor placement is impossible. BIS monitoring of the depth of anesthesia is most advantageous in the following cases: epilepsy surgery, spine surgery with neurophysiological monitoring, awake craniotomy, severe cardiovascular pathology, massive blood loss, neurosurgery in pregnant patients.

The abdominal compartment syndrome (ACS) can lead to multiple organ dysfunction syndrome (MODS), sepsis and death. In neurosurgical patients ACS used to be interesting for specialists only in respect of its impact on ICP. However injury of diencephalic structures of the brain can theoretically cause ACS. The goal of the study is to assess the efficacy of conservative therapy and epidural anesthesia for ACS treatment in postoperative period in patients with tumors of the sellar region. 41 patients were enrolled in the study. The epidural anesthesia at T8-T9 level by bupivacaine was applied for three days in the case of ACS development and ineffective conservative therapy. Intra-abdominal hypertension (IAH) developed in 28 cases, ACS - in 9. IAN usually revealed itself on the second day after surgery, ACS - on the 3rd-6th day. Gastrointestinal tract paralysis developed earlier than IAH and continued longer than IAH. Conservative therapy was effective only in every third patient with ACS. Epidural anesthesia was used in 4 cases and appeared effective in all of them. All patients with ACS not provided by epidural anesthesia died. We conclude that conservative therapy is effective in IAH, but not in ACS cases. Epidural anesthesia is an effective method to treat ACS and should be used in all patients with ACS without sepsis.

The review contains brief description of modem anesthetic approaches used in intractable epilepsy surgery. The authors describe main types of neurosurgery operations for intractable epilepsy, as well as the basic anesthetics and anesthetic plans and their influence on the intraoperative ECoG. Another issue raised is awake craniotomy - an anesthetic method with intraoperative emergence for verbal contact between patient and psychologist. We conclude that epilepsy surgery is one of the neurosurgery fields where anesthesiologist can significantly affect the outcome of the operation.

The survey studies analgesic effect of postoperative therapy in two groups of patients with spinal disorders. In the first group the standard scheme with NSAID on demand was used. In the second group transdermal therapeutic system Duragesic Matrix was applied. The pain level (by pain level scale) as well as psychological status and IL-6 rate (a reliable indicator of surgical trauma and pain severity) were assessed before and after surgery. Transdermal therapeutic system Duragesic Matrix applied before surgery appeared to be more effective for analgesic therapy than standard scheme with NSAID on demand.

A clinical example shows that after a neurosurgical operation in posterior fossa there could appear intracranial pressure difference between supra- and infratentorial spaces. This difference develops due to pressure rise in posterior fossa and maintenance of this hypertension postoperatively. Hypertension in posterior fossa and intracranial difference are accompanied by brainstem reactions and temporary neurological disorders. While the pressure difference decreases and ICP in posterior fossa normalizes the neurological symptoms disappear. ICP in supratentorial space not necessarily correlates with ICP in infratentorial space. In some cases it is necessary to measure ICP in infratentorial space after posterior fossa surgery.

The paper written in the format of lecture, focuses on practical problems of neuroanesthesiology, current tendencies in technologies and medicaments, prevention and management of complications.

Currently problem of intraabdominal hypertension in patients with brain tumors is practically uninvestigated. Authors describe a case of complicated course of early postoperative period in the patient with craniopharyngioma due to secondary abdominal compartment-syndrome. Causes of intraabdominal hypertension in patients with CNS lesions requiring intensive care are analyzed. Risk factors of intraabdominal hypertension deserving attention in management of patients in neurolCU are determined.

The analysis of the results of bilateral monitoring of the depth of anesthesia in 22 patients with neurosurgical pathology of the posterior cranial fossa using the technique bispectral index (BIS). The results showed that more than half of the observations (at 19 and 22 patients) during the main phase of the operation (removal of the tumor) were observed differences in the BIS index values between the right and left side. In 1/3 of patients, these differences were driven by higher values of BIS on the side of surgery. By the end of removal of the tumor and, particularly, by the end of surgery there was a complete alignment of values of the BIS on the right and left.

Fever is a proven factor in secondary brain damage and worsens outcome in neuro intensive care patients. However, large randomized studies have shown neuroprotective effects of induced hypothermia only in patients with cardiac arrest and in neonates with perinatal hypoxic-ischemic brain damage. Nevertheless, now there is an active search for alternative modes of temperature correction, which would have been effective in other groups of patients with brain damage. Moreover, new management techniques of body temperature are being created. In this paper we presented a series of 10 observations when the used cooling system was CoolGard/CoolLine. 5 patients underwent hypothermia, 5 patients normothermia . Hypothermia was used for cerebroprotection in 1 case and for the correction of resistance to the therapy of intracranial hypertension in 4 cases. Normothermia was used for correction of resistance to pharmacological treatment of fever. In all cases the target temperature was achieved, and only for 1 patient to achieve hypothermia additional external cooling was used. Patients with normothermia did not need sedation, because they have not developed discomfort and muscle tremor. 2 patients died, in one case was due to intracranial hypertension and hemotamponade of brain ventricular system. Cause of second death was pulmonary embolism. Thus, the CoolGard system effectively lowers the body temperature to the target values for neuro intensive care patients. Application of this system is relatively safe. However, the most dangerous are the thromboembolic complications, thus the daily ultrasound scanning of lower limb veins and the possible early use of low molecular weight heparins is crucial.

The paper describes a rare clinical case of severe thrombotic complications (thrombosis of the subclavian, superior vena cava and femoral veins) of the child in the postoperative period, after removal of craniopharyngeoma. The development of complications was diagnosed based on clinical symptoms and results of ultrasound. Genesis of thrombotic complications has been clarified with the help of special hemostasiological studies that confirmed the presence of acquired protein S deficiency. The matters of discussion are the problems of diagnosis and therapy of this complication.

The paper describes two cases of posterior cranial fossa pathology, operated on in the sitting position on the operating table. In one case, symptoms of cervical spine injury caused by undiagnosed preoperative cervical spine pathology emerged in a female patient in the early postoperative period. In the other case, cervical spine pathology was diagnosed before surgery and evoked potentials were monitored to prevent possible cervical spine injury in the sitting position during an operation.

Based on the data on the current literature, the authors present the basic physiological and pathophysiological aspects of measurement of intracranial pressure and discuss indications for its monitoring and clinical value.

The paper describes a case of multiple cerebral arterial aneurysms in a patient with prior subarachnoidal hemorrhage, who developed postoperative acute upper gastrointestinal tract (GIT) lesion manifesting itself as bleeding and requiring multiple endoscopic treatment procedures and eventually a direct surgical intervention. The susceptibility of patients with cerebral pathology to upper GIT lesions and methods of their therapy and prevention are discussed.

The paper gives the results of the first clinical use of recombinant human erythropoietin (rhEPO) within the blood-saving program in neurosurgical patients with preoperative anemia of various genesis and predictable massive intraoperative blood loss. A course of effective therapy with rhEPO is shown to increase hemoglobin and packed cell volume rather rapidly in all patients prior to surgery. This made it possible to effectively apply other blood-saving procedures (isovolemic hemodilution and instrumental reinfusion of washed red blood cells) and to reduce the volume required for the use of donor transfused media in these patients. Various clinical aspects of the use of rhEPO in these patients are discussed.

The paper discusses pre- and intraoperative application of different guiding techniques (frameless neuronavigation, fMRI, electrophysiological monitoring). We performed comparative analysis of different combinations of these methods. 74 patients with intracerebral tumors involving eloquent areas (sensorimotor cortex in 56 and speech zones in 18) were operated. In 9 cases 'awake surgery' was applied. We found that frameless navigation combined with brain mapping allows to optimize planning of surgical approach and to decrease postoperative neurological deficit. Also in certain cases 'awake craniotomy' can be replaced by fMRI and neuronavigation.

The paper describes an unusual clinical case. During a neurosurgical operation (removal of parastem tumor (neuroma) on the right side), bilateral registration of the bispectal index (BSI) in order to monitor a hypnotic component of anesthesia showed that the tumor removal stage was marked by a paradoxical reaction of the BSI as an increase in its values up to 70-80% (corresponds to the patient's emergence) on the right, ipsilaterally, with the preserved low BSI values on the left--30-40%. Possible explanations of the observed are considered.

The study was undertaken to evaluate the efficiency and safety of oral premedication in children with intracranial neurosurgical pathology before elective interventions in two modalities: a combination of midasolam 0.5 mg/kg body weight and ketamine 3 mg/kg (Group 1; n = 80) and midasolam 0.75 mg/kg only (Group 2; n = 20). The study was conducted in 100 children aged 2 to 10 years. Medical and sweet syrups were used to dilute the agents. In Groups 1 and 2, an effective anxiolytic effect was achieved in 92 and 80%, respectively. A sedative effect was also more pronounced in Group 1 children. The mean duration of effect achievement was 20 minutes. There were no serious complications when both regimens were used. Both oral premedication modes are considered to be effective and must be used for premedication in children with neurosurgical diseases.

Xenon is a promising anesthetic agent in neurosurgery. However, there is now little evidence on the effect of xenon at anesthetic concentrations on brain electrical activity, which limits its use in neurosurgical patients. Changes in brain bioelectrical activity were studied in patients with skull base tumors before surgery (conscious ones) and at different stages of xenon anesthesia (after denitrogenization, at 50% xenon concentration in the circuit, at 65% xenon concentration in the circuit, during steady-state xenon anesthesia, and after hyperventilation). EEG during xenon anesthesia was similar to that during propofol anesthesia; a circuit xenon concentration (50 or 65%) and a ventilation mode had no considerable impact on EEG. Xenon did not induce paroxysmal activity. The findings suggest that the use of xenon anesthesia in neurosurgical patients is safe in terms of its impact on brain bioelectrical activity.

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.

The results of using three infusion solutions, such as 6% hydroxyexyethyl starch (HES) 200/0.5 (HaesSteril), HES 130/0.4 (Voluven), and 4% modified gelatin solution (Gelofusin), were compared in 33 patients with neurosurgical diseases of the brain (supratentorial meningovascular tumors) and predictable massive intraoperative blood loss during acute isovolemic hemodilution and compensation for later blood loss. The evaluation criteria were volemic, hemostatic and cerebrovascular effects. The most marked and longest volemic effect was observed in the Voluven group. The least hemostatic changes were seen in the Gelofusin group. The findings suggest that among the test infusion solutions, Voluven is most effective and Gelofusion is safest.

The literature contains rare reports on anesthetic maintenance in non-cardiac operations in patients with dilated cardiomyopathy and an ejection fraction of less than 30%. Life-saving non-cardiosurgical interventions are performed in these patients since they are associated with a high risk for perioperative complications and fatal outcome. In these cases, anesthetic maintenance is performed with inotropic support; there is frequently a need to use a pacemaker, a cardioverter, or a LV assist device. The paper describes the first case of xenon anesthesia in a patient with dilated cardiomyopathy with an ejection fraction of less than 30% and rapidly progressing spinal cord tumor. The ability of xenon to maintain stable blood pressure and cardiac contractility could prevent perioperative infusion of inotropic agents. In 60-70% of cases, the maximum alveolar concentration of xenon enables anesthesia to be virtually performed as monoanesthesia without adding the anesthetics lowering cardiac contractility; the low blood-gas distribution coefficient ensures early emergence from anesthesia with early extubation and activation of a patient. In the author's opinion, xenon anesthesia has every reason to become the method of choice as anesthetic maintenance in patients with severe cardiac dysfunction.

The paper gives the results of a study of the time course of changes in the major laboratorily determined hemostatic parameters, as well as the main characteristics of a thromboelastographic curve in 95 neurosurgical patients who developed significant intraoperative blood loss at surgery. The patients were divided into 2 comparable groups: 1) a decision on fresh frozen donor plasma transfusion was taken only on the basis of laboratory parameters; 2) this was done on the basis of thromboelastographic data. In Group 2, the frequency of fresh frozen donor plasma transfusion proved to be 4 times less than that in Group 1. The use of thromboelastography to evaluate the hemostatic system during operations with a significant blood loss volume permits a reduction in the frequency of fresh frozen donor plasma, without deteriorating the results of treatment.

The paper gives a brief review of the engineering solutions now applied to the clinical use of a blood reinfusion procedure. It considers simple, transient, and sophisticated (automatic) blood reinfusion methods, their advantages and disadvantages, and the areas of their possible clinical application.

The paper analyzes the use of a method of thromboelastography (TEG) as a screening technique of diagnosing hemostatic disorders in risk-group neurosurgical patients: hemostatic disorders detectable from the data of routine laboratory tests; the administration of anticoagulants and desaggresants, the use of anticonvulsants causing impairments in the hemostatic system, hematological diseases, and hepatic cirrhosis. As compared with the routine laboratory tests, TEG is shown to diagnose hemostatic disorders accurately and promptly and to monitor the efficiency of their therapy.

The paper describes a case of the relatively rare complication transfusion-associated lung injury (TRALI) in the early postoperative period in a female patient who has experienced intraoperative massive blood loss and blood transfusion. It also considers the causes of this complication, its clinical symptoms and differential diagnosis, as well as a package of therapeutic measures and possible lines of prevention.

The paper describes a case of the hemorrhagic event--as high as 1500 ml hematoma--resulting from femoral arterial catheterizing puncture for invasive hemodynamic monitoring in a seriously ill neurological care unit patient. The causes of this complication and possible ways of its prevention are discussed.

An objective of the study is an analysis of the results of surgical treatment and influence of resection volume on the treatment outcome. Sixty-four patients, aged 7-46 years, with an epileptic focus in a temporal lobe have been studied. Patients have been stratified into 2 groups. The first group included 55 patients with epileptogenic lesions of a temporal lobe (monoregional lesions) and the second one--9 patients who, along with the lesion of one temporal lobe, had the signs of lesions in other brain areas (multiregional lesions). In the group of patients with monoregional lesions, a resection of the affected area has been performed. In other patients, the techniques of resection of frontal-medial temporal lobe regions within the scope of the area of steady epileptiform activity have been used. The results have been assessed with the modified Engel scale: class I--an absence of clinically manifested seizures (auras are possible); class II--seizures that do not impact quality of life; class III--a decrease of seizures frequency by more than 80%; class IV--an absence of substantial improvement. In the monoregional lesions, the satisfactory results (I-II classes) were observed in 39 patients (74%), including outcomes of class I (28 patients). In other 16 cases outcomes of classes III and IV were observed. In the multiregional lesions and cryptogenic (possibly symptomatic) partial epilepsy, outcomes of classes III and IV were observed in all patients, regardless of the resection volume. In conclusion, the highest efficacy with regard to frequency and severity of seizures is achieved by resections including the whole area of visualized lesion and border-line area of steady epileptic activity, the identification of which demands the intrasurgery neurophysiologic study. In the extensive and multiregional lesions, the resection surgery confined to one temporal lobe has low effect.

The paper analyzes the clinical effectiveness of various blood-sparing techniques (hypervolemic hemodilution, isovolemic hemodilution, and instrumental infusion of washed autoerythrocytes) in neurosurgical interventions (n = 93) in 89 patients. Hypervolemic hemodilution that remains, however, to be the method of choice for young and low-weight children has proved to be the least clinically effective as a method for blood saving. The blood-sparing effectiveness of isovolmic hemodilution and instrumental reinfusion of washed autoerythrocytes is about the same, but the efficiency of reinfusion was higher with a blood loss volume of more than 100% of the proper volume of circulating complexes. A combination of hemodilution and instrumental reinfusion of autoerythrocytes provides a summation of blood-sparing effects for the mechanisms of blood saving vary with these techniques. The use of any blood-sparing technique accelerates and worsens hemostatic disorders.

The paper gives the results of a clinical study of the effect of the new combined hypertonic colloidal and hypertonic solution HyperHaes (Frezenius-Cabi) on the parameters of systemic hemodynamics (invasive evaluation by means of a Swan-Ganz catheter), systemic oxygen transport, intracranial pressure (ICP) (lumbar spinal fluid pressure), and cerebral oximetry (INVOS 5100) in neurosurgical patients. The paradoxical effect was found as acute blood pressure lowering and elevated ICP on the beginning of solution infusion (the vasodilator effect of a distinctly hyperosmolar agent). In all other respects, HyperHaes is an ideal agent for volumetric compensation in neurosurgical patients.