[Redo surgery in children with epilepsy]. / Povtornye operatsii v khirurgii epilepsii u detei.

OBJECTIVE: To analyze the causes of ineffective operations and the results of redo surgery in children with recurrent epileptic seizures. MATERIAL AND METHODS: The results of redo surgery were analyzed in 41 (10.6%) out of 387 children with drug resistant epilepsy treated surgically at the Russian Polenov Neurosurgical Institute for the period from 1994 to 2014. Patients with recurrent epilepsy after temporal resection (n=20), extratemporal resection (n=7), multifocal resection (n=6), callosotomy and stereotaxic destruction (n=8) were selected for analysis. RESULTS: Seizure-free period ranged from early postoperative period to 4 years. According to MRI data, lesions were not completely resected during primary surgery in 23 (56.1%) children. The causes of inefficiency of primary operations were inaccurate identification of epileptic focus in 15 (36.6%) patients; incomplete resection of epileptogenic and / or epileptic foci or incomplete disconnection of paroxysmal activity distribution pathways in 14 (34.1%) cases; epileptic foci de novo in 8 (19.5%) cases; inadequate surgical strategy in 4 (9.8%) patients. Redo surgery usually implied an extended previous resection in 34 (82.9%) patients. Engel I outcome after 3 years was achieved in 41.1% of patients, after 5 years - 38.3%, after 10 years - 36.4%. CONCLUSION: Redo surgery is quite effective and minimally traumatic. Therefore, patients with recurrent epileptic seizures should be considered as candidates for repeated operations if previous interventions turned out to be ineffective.

Surgical treatment of Chiari I malformation with or without syringomyelia.

102 patients with Chiari I malformation with or without syringomyelia underwent primary reconstructive operation at the craniocervical junction (CCJ). We present here the indications, methods of surgical management with clinical, radiological and operative findings. Here we present the results of a retrospective review. The authors discuss the possible ways of improvement in the results of "hindbrain related" syrngomyelia treatment.

[Neurosonography after operations for syringomyelia and the Arnold-Chiari malformation type 1]. / Neirosonografiia posle operatsii po povodu siringomielii i mal'formatsii Arnol'da--Kiari tipa 1.

The paper provides the authors' experience in using neurosonography in the diagnosis of osteoneural abnormalities of the vertebral canal and craniovertebral passage in 22 patients operated on for syringomyelia and Type 1 Arnold-Chiari malformation. Comparison of computed tomographic and X-ray findings and intraoperative verification indicate that neurosonography is of high informative value and they provide evidence for its use in a diagnostic set of follow-ups of patients operated on.

[The transplantation of embryonic nerve tissue in syringomyelia: initial clinical experience]. / Transplantatsiia émbrional'noi nervnoi tkani pri siringomielii: pervyi klinicheskii opyt.

The paper gives clinical findings of 5 cases of syringomyelia surgical treatment using neurotransplantation of embryonal spinal marrow nerve tissue into the intramedullary cavity. It also discusses problems of sampling, culture and transplantation of embryonal spinal marrow nerve tissues, as well as the results and prospects of this method application.

[A comparative evaluation of the effect of glurenorm and sulfonylurea preparations on the intravascular microcirculatory indices in type-II diabetes mellitus]. / Sravnitel'naia otsenka vliianiia gliurenorma i nekotorykh preparatov sul'fonilmocheviny na pokazateli vnutrisosudistoi mikrotsirkuliatsii pri sakharnom diabete II tipa.

Analysis of the effects of glurenorm and some sulfonylurea drugs, such as maninil, minidiab, chlorpropamide, on some parameters of intravascular microcirculation has demonstrated the specific features of this drug. Though all these hypoglycemic agents favorably influence the microcirculation when carbohydrate metabolism compensation is attained, glurenorm improved the status of formed elements of the blood (red cell and platelet aggregation) more noticeably than the rest drugs, which fact recommends it as a drug of choice for patients with type II medium-severe diabetes with the predominant involvement of the cellular component of the microcirculation.

Surgical treatment of "hindbrain related" syringomyelia: new data for pathogenesis.

52 patients with "hindbrain related" syringomyelia underwent surgical treatment. All patients underwent primary reconstructive surgery at the craniovertebral junction. Terminal ventriculostomy was performed as the secondary operation in 2 cases. The surgical treatment arrested progression of signs in 33 (63.5%), stabilized disease in 9 (17%) cases. Postoperative deterioration occurred in 8 (15%) cases. Mortality was 4% (2 patients). Percutaneous or intra-operative injection of myodil and gas into the syrinx, as well as CT, revealed the existence of communication with the 4th ventricle in 14 patients. Investigation of cerebrospinal and syrinx fluid revealed increased level of IgG, IgM or IgA in the syrinx fluid in 16 out of 22 patients. Immunohistological examination of pia mater revealed specific staining for IgG. Thus, syrinx formation may be due to synergic action of hydrodynamic and immunopathological mechanisms. Results indicate that early surgical treatment is preferable to patients with hindbrain anomalies and hydromyelia. We consider primary reconstructive operation at the posterior fossa as the preferred surgical management of "hindbrain related" syringomyelia.

[Clinico-immunological and pathomorphological correlations in syringomyelia]. / Kliniko-immunologicheskie i patomorfologicheskie korreliatsii pri siringomielii.

The authors provide the results of studying humoral immunity of the blood serum, CSF and cystic fluid and pathomorphological alterations in the spinal membranes of 16 operated patients with communicating syringomyelia, which form the basis for viewing the immune mechanism as an important component of the pathogenesis of cyst formation. The indicators of humoral immunity mirror the activity of syringomyelia pathomorphosis and can be used for estimation of the time course of changes in the process and of the efficacy of the treatment given to the patients.

[Clinical variants of Arnold-Chiari deformity in adults]. / O klinicheskikh variantakh anomalii Arnol'da-Kiari u vzroslykh.

The data of the clinico-neurological, roentgenological and computer-aided diagnosis of Arnold-Chiari deformity are provided. Different variants of the disease and characteristic features of neurological symptomatology are discussed as are pathognomonic symptoms, diagnosis and differential diagnosis, indications for surgical treatment.

[Reactive-inflammatory and degenerative-dystrophic changes in the nervous system in experimental syringomyelia]. / O reaktivno-vospalitel'nykh i degenerativno-distroficheskikh izmeneniiakh v nervnoi sisteme pri ékperimental'noi siringomielii.

The results of immunomorphologic and histochemical investigations of 12 rabbits with experimental syringomyelia are presented. Chronic pachymeningitis of the hind brain, resulting from the administration of kaolin leads to the disorders of liquor circulation on the level of outlet of the fourth ventricle this being a start mechanism for the cavity formation in the spinal cord. The reactive inflammatory, degenerative and immune reactions accompany the formation of cavity in the nervous tissue. The formation of cavity is followed by asymmetrical segment demyelination and reparative hyperplasia of the astroglial cells and gliosis of the cavity walls.