ABSTRACT
We report a patient with recurrent glioblastoma in eloquent brain area. Stereotactic fluorescence biospectroscopy and stereotactic photodynamic therapy of tumor in opercular area of the left frontal lobe under neurophysiological monitoring were carried out. Literature data on this issue were analyzed.
Subject(s)
Brain Neoplasms , Glioblastoma , Photochemotherapy , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/drug therapy , Fluorescence , Glioblastoma/diagnostic imaging , Glioblastoma/drug therapy , Glioblastoma/surgery , Humans , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/drug therapyABSTRACT
The need in replacement of a dura mater (DM) defect occurs in more than 40% of cerebral interventions. Various artificial DM substitutes facilitate solving this problem; however, their efficacy compared to that of patient autogenous tissues has been poorly understood. AIM: We aimed to study the efficacy of various substitutes in repair of dura mater defects. MATERIAL AND METHODS: The study included patients with various intracranial pathologies who were operated on at the Neurosurgery Clinic of the Military Medical Academy in the period between 2010 and 2017, and who underwent repair of the DM during surgery. In surgery for the supratentorial structures, patient autogenous tissues, grafted non-resorbable materials, or applicable collagen matrices were used as substitutes. Depending on the type of substitute material, patients were divided into groups to assess the efficacy of DM closure by comparing the rate of postoperative liquorrhea. In surgery for the posterior cranial fossa (PCF), applicable dural substitutes were not used; in this cohort, the efficacy of autogenous tissues and synthetic materials was compared. RESULTS: In 232 patients, the total rate of liquorrhea was 23.7%. In supratentorial surgery (175 cases), the use of autogenous tissues (n=73), synthetic materials (n=42), and collagen matrices (n=60) was associated with CSF exfusion in 13 (17.8%), 13 (31.0%) and 16 (26.7%) cases, respectively; in statistical analysis, these results were comparable (p>0.05). In PCF surgery (57 cases), the use of autogenous tissues (n=34) significantly more effective (p=0.021) prevented liquorrhea compared to synthetic materials (n=23): complications occurred in 4 (11.8%) and 9 (39.1%) cases, respectively. CONCLUSION: If a DM defect is located supratentorially, the choice of a dural substitute affects the rate of CSF exfusion and related complications. The use of autogenous tissues in PCF surgery statistically significantly reduces the rate of liquorrhea compared to that of synthetic materials.
Subject(s)
Brain Diseases , Collagen , Dura Mater , Brain Diseases/surgery , Cranial Fossa, Posterior , Dura Mater/surgery , Humans , Neurosurgical Procedures/methods , Postoperative ComplicationsABSTRACT
Military operations in various parts of the world in the early 2000s are becoming more regionalized; new warfare tactics emerge, which makes it necessary to review and modify the neurosurgical care system. The article reviews the results of original studies on this issue and summarizes the experience of the US Army medical service in Afghanistan and Iraq. The article discusses the structure of sanitary losses, organization and scope of medical and evacuation neurosurgical measures, types and techniques of surgical interventions, and the rate of complications. We describe five levels of neurosurgical care echelons and an implemented "injury control - neurosurgery" concept; particular attention is paid to the peculiarities of research and specialist training. We demonstrate that implementation of the new concept for organization and scope of neurosurgical care has improved treatment outcomes and reduced the mortality rate in the mentioned military conflicts of recent years compared to those in the Vietnam War. We may conclude that the described experience of the US Army can be used to improve the efficacy of neurosurgical care to the wounded and victims of armed conflicts.