Search

Introduction. Volume of glioma resection positively correlated with treatment results. Advance in extent of resection due to various additive methods leads to prolonged overall survival and delays progression. Our aim was to evaluate the value of intraoperative magnetic resonance imaging.Objective – to present the first experience of using intraoperative magnetic resonance imaging and evaluate the effectiveness and safeness of this technique in surgery of glial brain tumors.Material and methods. Prospective analysis of surgical interventions performed using the intraoperative magnetic resonance imaging and the results of neuroimaging in 9 patients with different grade brain gliomas treated in Federal Brain and Neurotechnology Center was carried out.Results. In all patients we detect variable residual tumor volume after first resection. Additional resection was performed in all cases after the intraoperative magnetic resonance imaging. Mean scan time were 45 minutes overall time for scan were decreasing as we gain experience in using intraoperative magnetic resonance imaging.Conclusion. Intraoperative high-field intraoperative magnetic resonance imaging can be successfully used in the surgery of brain gliomas. The technique allows increasing the radicality of tumor removal without increasing the risk of complications.

Background The necessity of spinal segment fusion after decompression is one of the most controversial and unresolved issues in single-level lumbar spinal stenosis surgery. To date, only one trial carried out 15 years ago focused on this problem. The key purpose of the current trial is to compare the long-term clinical results of the two surgical methods (decompression vs. decompression and fusion) in patients with single-level lumbar stenosis. Methods This study is focused on the non-inferior clinical results of decompression compared with the standard fusion procedure. In the decompression group, the spinous process, the interspinous and supraspinous ligaments, part of the facet joints, and corresponding parts of the vertebral arch are to be preserved intact. In the fusion group, decompression is to be supplemented with transforaminal interbody fusion. Participants meeting the inclusion criteria will be randomly divided into two equal groups (1:1), depending on the surgical method. The final analysis will include 86 patients (43 per group). The primary endpoint is Oswestry Disability Index dynamics at the end of the 24-month follow-up compared to the baseline level. Secondary outcomes included those estimated using the SF-36 scale, EQ-5D-5L, and psychological scales. Additional parameters will include sagittal balance of the spine, fusion results, total cost of surgery, and hospital stay followed by two-year treatment. Follow-up examinations will be performed at 3, 6, 12, and 24 months Discussion Authors suggest that this study will improve the evidence for application of various surgical techniques for lumbar spine stenosis surgery and verify the existing protocol for surgical management. Trial registration ClinicalTrials.gov NCT05273879. Registered on March 10, 2022, https://clinicaltrials.gov/ct2/show/NCT05273879

Transcranial and transnasal approaches are the most common techniques for treatment of diseases and injuries of the eye socket and the base of the skull. However, development of endoscopic technology, microsurgical devices and minimally invasive techniques promotes increased interest in transorbital endoscopic approaches which allow to perform manipulations in the eye socket and structures of the base of the skull, namely, the anterior and middle cranial fossa. There are 4 types of such approaches: pre-caruncular, superior transpalpebral, lateral retro-canthal and inferior preseptal. Currently, precise indications for transorbital approaches are not formulated, and there are no algorithms for approach selection. The article describes the results of using these approaches in treatment of diseases and injuries of the orbit and the base of the skull. In injuries and tumors of the orbit and the base of the skull, cerebrospinal liquid leakage, infectious diseases, endocrine ophthalmopathy, transorbital endoscopic techniques provide good functional and cosmetic results. Among the advantages of these approaches are larger orbitotomy area and preservation of nasal structures, absence of large neurovascular bundles in the way of the approach, small incision, minimal brain retraction, good visibility and illumination of the structures. Transorbital endoscopic approaches to the base of the skull aren’t associated with significant neurological or vascular complications, hemorrhage, hematomas, infections. Diplopy, ptosis, enophthalmia are also quite rare. In literature, there are no descriptions of cases of loss of vision or postoperative cerebrospinal liquid leakage.

AIM OF STUDY: to improve the results of surgical treatment of patients with endocrine ophthalmopathy complicated by optical neuropathy. For this, medial orbitotomy and decompression of the optic nerve were performed for a patient with endocrine ophthalmopathy, CASRESULTS. The postoperative period was uneventful. In the early postoperative period, regression of exophthalmos was observed OD=18 mm, OS=20 mm, improvement in visual acuity OD=1.0 OS=0.5 . No complications were recorded. A satisfactory result was obtained.CONCLUSION. Transorbital endoscopic medial orbitotomy and optic decompression can be effectively used in the treatment of patients with endocrine ophthalmopathy complicated by optic neuropathy, refractory to conservative therapy. The technique is promising and requires further randomized studies.

Objective: To improve the results of surgical treatment of patients with cranioorbital tumors. For this purpose, for patient with high vascularized tumor of ethmoidal bone, adjacent to the medial wall of the orbit, early devascularization as the first stage and transnasal endoscopic removal of the tumor as the second stage was performed. Tumor devascularization was performed by clipping of anterior and posterior ethmoidal arteries through a transcaruncular endoscopic approach. For this, the incision of the conjunctiva, after infiltration with local anesthetics, was carried out posteriorly from the lacrimal caruncle, continuing it above and below the posterior border of the medial canthal ligament. Then, after dissection of the periosteum posterior to the posterior lacrimal crest, further stages of the surgical intervention are performed under the control of an endoscope with a viewing angle of 0°. Results. Transorbital endoscopic clipping of the ethmoid arteries allowed to significantly reduce the intensity of blood flow in the tumor tissue and perform endoscopic transnasal removal of the tumor with minimal blood loss. Intraoperative blood loss was 100 ml. No complications were recorded. Conclusion. Transorbital endoscopic clipping of the anterior and posterior ethmoidal arteries is an effective and safe method for early devascularization of partially embolized or non-embolized cranioorbital tumors. The technique is promising and requires further development.

The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

Study Design: A multicenter observational survey. Objective: To quantify and compare inter- and intraobserver reliability of the subaxial cervical spine injury classification (SLIC) and the cervical spine injury severity score (CSISS) in a multicentric survey of neurosurgeons with different experience levels. Methods: Data concerning 64 consecutive patients who had undergone cervical spine surgery between 2013 and 2017 was evaluated, and we surveyed 37 neurosurgeons from 7 different clinics. All raters were divided into 3 groups depending on their level of experience. Two assessment procedures were performed. Results: For the SLIC, we observed excellent agreement regarding management among experienced surgeons, whereas agreement among less experienced neurosurgeons was moderate and almost twice as unlikely. The sensitivity of SLIC relating to treatment tactics reached as high as 92.2%. For the CSISS, agreement regarding management ranged from medium to substantial, depending on a neurosurgeon’s experience. For less experienced neurosurgeons, the level of agreement concerning surgical management was the same as for the SLIC in not exceeding a moderate level. However, this scale had insufficient sensitivity (slightly exceeding 50%). The reproducibility of both scales was excellent among all raters regardless of their experience level. Conclusions: Our study demonstrated better management reliability, sensitivity, and reproducibility for the SLIC, which provided moderate interrater agreement with moderate to excellent intraclass correlation coefficient indicators for all raters. The CSISS demonstrated high reproducibility; however, large variability in answers prevented raters from reaching a moderate level of agreement. Magnetic resonance imaging integration may increase sensitivity of CSISS in relation to fracture management.

The study objective is to analyze the results of surgical treatment of patients with endocrine ophthalmopathy using minimally invasive transorbital approaches and intraoperative frameless neuronavigation.Materials and methods. The study was based on the results of examination and surgical treatment of 9 patients with endocrine ophthalmopathy (17 orbits) in the period from 2015 to 2017. At the first stage the preoperative computed tomography images of the orbits was imported into the navigation software program, and then the area of the proposed resection of the orbit walls was marked. Further, in the operating room, the patient head position was registered in the navigation system. To perform bone decompression of the orbit and lipectomy, we used preseptal, transcaruncular and lateral retrocanthal approaches. These approaches are transconjunctival and do not leave postoperative scars. Upon completion of the orbitotomy, its accuracy and dimensions were determined by the intraoperative pointer of the neuronavigation system.Results. The postoperative period was uneventful. In all patients, according to clinical examination and computed tomography, good cosmetic and functional results were achieved. Only 1 patient developed a simblypharon after transconjunctival access, which required additional intervention to reconstruct the lower eyelid. There were no other complications of surgical treatment. The minimum degree of regression of exophthalmos was 3 mm, the maximum 7 mm. Diplopia completely regressed in 2 patients. The observation period was 6 months.Conclusion. Minimally invasive transorbital approaches allow the transconjunctival view of all orbital walls to perform decompression of the orbit and lipectomy without cutaneous incisions, to achieve good cosmetic and functional results. The intraoperative use of the neuronavigation system ensures the bone decompression of the orbit in full.

Актуальность. Сохранение зрительных функций у пациентов с аденомой гипофиза (АГ) возможно при ранней диагностике компрессионной оптической нейропатии и своевременном проведении декомпрессии. Цель. Анализ ОКТ-А параметров у пациентов с АГ. Материал и методы. Обследован 21 пациент (42 глаза) с АГ и 10 здоровых человек (20 глаз), сопоставимых по полу и возрасту. Пациенты были разделены по результатам тестирования центрального поля зрения (ЦПЗ) на периметре Galaxypro(MS WestfaliaGmbH, Германия) с использованием стандартного протокола 30-2 на группы – без нарушений в ЦПЗ на обоих глазах (группа 1 – 22 глаза) и с нарушениями в ЦПЗ (преимущественно темпоральные дефекты) на одном или обоих глазах (группа 2 – 20 глаз). ОКТ-А проведена на спектральном томографе REVO nx/SOCT Copernicus REVO (OptopolTechnologyLtd., Польша). Результаты. В 1-й группе выявлено снижение: плотности сосудов (VD) радиального перипапиллярного капиллярного сплетения (RPC) в верхней перипапиллярной зоне (p=0,002), в верхнем (p=0,005) и верхневисочном (p=0,004) секторах; снижение показателя капиллярной перфузии (VP) поверхностного капиллярного сплетения (SRCP) в нижнем секторе наружного кольца по сетке ETDRS (p=0,009); VP глубокого капиллярного сплетения (DRCP) общего внутреннего кольца (p=0,003). Во 2-й группе выявлено снижение: VDRPC по сравнению с 1-й группой – в верхневисочном секторе (p=0,003), по сравнению с контрольной группой – во всех секторах (p

The authors report simultaneous surgical treatment of the right S1 root schwannoma with extravertebral retroperitoneal spread. Well-equipped operating theatre, professional experience and multidisciplinary approach involving neurosurgeons and abdominal surgeons ensure total minimally invasive simultaneous resection of schwannoma via posterior median and laparoscopic approach.Представлено клиническое наблюдение симультанного оперативного лечения невриномы правого спинномозгового корешка S1 с экстравертебральным ретроперитонеальным распространением. Операционная, полностью оснащенная современным хирургическим оборудованием, профессиональный опыт и мультидисциплинарный подход к лечению у нейрохирургов и абдоминальных хирургов позволили выполнить радикальное, минимально инвазивное одномоментное удаление образования из заднего срединного и лапароскопического доступа.

To compare an effectiveness of different methods of rigid transpedicular fixation and decompression in patients with degenerative lumbar stenosis.A prospective study included 160 patients with degenerative lumbar spine stenosis. In the first group (Satisfactory result was noted in 103 patients (64%) in 2 years after surgery. Outcomes were comparable in all groups. More significant regression of back pain was noted in group II (laminectomy, transpedicular fixation, interbody cage) compared to other groups. Preoperative risk factors of adverse outcome were resting leg pain VAS score4 and age over 71 years. Incidence of pseudoarthrosis and back pain was higher among patients without interbody cage. Incidence of adjacent level lesion was higher among patients with interbody cages.Decompression type and implantation of interbody cage do not significantly change postoperative outcomes in most patients with degenerative lumbar stenosis undergoing transpedicular fixation. However, interbody cage implantation during transpedicular fixation is advisable in patients with severe back pain (VAS score5-6).В настоящее время окончательно не определена тактика в плане выбора способа ригидной транспедикулярной фиксации и декомпресии у больных с дегенеративным поясничным стенозом. Результаты различных исследований противоречивы.Сравнить эффективность различных способов ригидной транспедикулярной фиксации и декомпрессии у больных с дегенеративным поясничным стенозом.Проведено проспективное исследование с включением 160 больных с симптомным дегенеративным стенозом позвоночного канала на поясничном уровне. Больным группы I (Через 2 года после операции удовлетворительный результат отметили у 103 (64%) пациентов. Исходы у пациентов всех четырех групп оказались сопоставимы друг с другом. У пациентов группы II (ляминэктомия, транспедикулярная фиксация, межтеловой кейдж) отмечен более выраженный регресс болевого синдрома в поясничной области по сравнению с пациентами других групп. Дооперационными факторами риска неблагоприятного исхода оказались уровень боли в ноге в покое более 4 баллов по ВАШ и возраст пациентов более 71 года. Частота псевдоартроза и боли в области транспедикулярной системы оказалась выше у пациентов без использования межтелового кейджа. Частота поражения смежного уровня была выше у пациентов с межтеловыми кейджами.При выполнении транспедикулярной фиксации у большинства пациентов с дегенеративным поясничным стенозом тип декомпрессии и установка межтелового кейджа существенно не меняют результат хирургического лечения. Однако если у пациента на уровне стеноза отмечается выраженная поясничная боль (более 5—6 баллов по визуально-аналоговой шкале), то транспедикулярную фиксацию целесообразно дополнять установкой межтелового кейджа.

Preservation of visual functions in patients with chiasmo-sellar region compression (CSRC) is possible with early diagnosis and surgical decompression.To analyze the parameters of optical coherence tomography (OCT) and optical coherence tomography-angiography (OCTA) in patients with CSRC.The study included 10 patients (20 eyes) with CSRC, 15 healthy volunteers (30 eyes). OCT, OCTA was performed on Cirrus HD-OCT 5000 AngioPlex™ (Carl Zeiss Meditec, U.S.A.) with AngioVue system.Patients with CSRC were revealed to have decreased thickness of ILM-RPE in the nasal sector of outer circle (In CSRC, changes can be seen in OCT and OCTA parameters recorded in the macular and peripapillary regions before the changes in the central visual field. Informative diagnostic OCT and OCTA criteria can help diagnose the pathology early, expand the indications for decompression, and preserve the visual funcitons.Сохранение зрительных функций при компрессии в хиазмально-селлярной области (КХСО) возможно при ранней диагностике и проведении хирургической декомпрессии.Анализ параметров оптической когерентной томографии (ОКТ) и оптической когерентной томографии-ангиографии (ОКТА) у пациентов с КХСО.Обследовано 10 пациентов (20 глаз) с КХСО и 15 здоровых добровольцев (30 глаз). ОКТ и ОКТА выполняли при помощи прибора Cirrus HD-OCT 5000 AngioPlex™ (Carl Zeiss Meditec, США) с функцией AngioVue.У пациентов с КХСО выявлены изменения ряда параметров, определяемых с помощью ОКТ и ОКТА, в макулярной области: уменьшаются толщина сетчатки ILM-RPE в назальном секторе наружного кольца (Заключение. При КХСО регистрируются изменения параметров ОКТ и ОКТА в макулярной и перипапиллярной областях до формирования нарушений центрального поля зрения. Информативные диагностические ОКТ- и ОКТА-критерии позволят своевременно диагностировать патологию, расширить показания для проведения декомпрессии, сохранить зрительные функции.