[Clinical features of temporal lobe epilepsy with involvement of the insular lobe]. / Klinicheskie osobennosti visochnoi epilepsii pri vovlechenii v protsess ostrovkovoi doli.

OBJECTIVE: To determine the clinical features of the course of the disease when the insular lobe is involved in the epileptic process. MATERIAL AND METHODS: A comparative analysis of the results of diagnosis and treatment of 55 patients with temporal lobe epilepsy and 46 patients with temporal plus epilepsy was carried out. The results of neuroimaging, clinical and EEG studies were compared. RESULTS: Autonomic paroxysms of nausea and hypersalivation, skin changes, simple motor seizures, emotional seizure and sensory paroxysms are the most reliable signs of the involvement of the insular lobe in the epileptic process in temporal plus epilepsy. For 'pure' temporal lobe epilepsy, cognitive paroxysms of the déjà vu and aura are common. When the insular lobe is involved in the epileptic process, the seizures have a reliably high frequency, polymorphism and are more complex by structure. CONCLUSION: Paroxysmal syndrome in temporal plus epilepsy with involvement of the insular lobe undergoes significant changes in the form of increased seizures and the appearance of specific seizures and characteristic polymorphism.

[Clinical, structural and functional features of paroxismal syndrome in insular and temporal lobe tumors]. / Klinicheskie i strukturno-funktsional'nye osobennosti paroksizmal'nykh rasstroistv, obuslovlennykh opukholyami ostrovkovoi i visochnoi dolei.

OBJECTIVE: To analyze the characteristics of paroxysmal syndrome in insular and temporal lobe tumors, to determine their relationship with the histological structure of tumor, to assess the effect of tumor growth nature on severity of disease. MATERIAL AND METHODS: A retrospective analysis enrolled 80 patients aged 11 - 80 years with insular and temporal lobe tumors and symptomatic epilepsy. All patients underwent surgery at the Polenov National Research Neurosurgery Center in Almazov National Medical Research Center for the period from 2012 to 2018. RESULTS: The main group consisted of 29 patients with tumors of temporal and insular lobes. Control group of 51 patients with temporal gliomas was formed for comparative analysis. It was found that involvement of insular lobe into paroxysmal syndrome is characterized by attacks with a motor component, somatosensory paroxysms, vegetative manifestations (respiratory attacks, salivation, nausea), speech disorders and taste hallucinations. Derealization, motor arrest and déjà vu/jamis vu paroxysms were more common in patients with temporal lobe lesion. Neoplastic lesion of the insular lobe shortens the period between manifestation of paroxysms and surgical treatment. Moreover, this type of disease is characterized by higher incidence of seizures compared to isolated temporal lobe tumors.

[VALUE OF ANATOMICAL INTRACRANIAL RESERVE IN SURGICAL TREATMENT OF INJURIES AND DISEASES OF THE BRAIN].

The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation.

[Value of the index of transversal dislocation of the brain in neurosurgery].

The complex clinical and radiation examination was made in 135 victims with craniocerebral trauma and in 120 patients with primary tumors of the brain. All observations evaluated the index of transversal dislocation of the brain. It included derivative of volume parameter of intracranial supratentorial substratum, the value of dislocation of ventricular system and its width relatively to the septum pellucidum and at the same time the state of mind according to Glasgow coma scale. High diagnostic informativity of developed and certified index of transversal dislocation in dif- ferent intracranial pathology allowed using the index for more wide application.

[Pericranial sinus. Definition, diagnosis, surgical treatment].

Pericranial sinus (Sinus pericranii - SP) is a rare pathology of the extra-intracranial cerebral venous system. However, SP is not just an additional transosseous canal that connects the extra- and intracranial venous systems. This "emissary vein" connects the intracranial sinus and the variceally extended thin-walled veins localized on the outer surface of the skull where blood flows fun in opposite directions. We present a literature review and two case reports of patients with pericranial sinus who underwent surgical treatment. We discuss the problems related to etiology, clinical signs, diagnosis, and surgical treatment of the anomaly.

[Surgical correction of circulatory disturbance of the vertebral artery in trauma and degenerative diseases].

The article presents the results of examination and surgery of 185 patients with degenerative diseases as well as with a cervical spine trauma. The circulatory disturbance of the vertebral artery took place in all patients. A different degree of changes was observed in color duplex scanning. There were minor circulatory disturbances, course deformations (angular, C, S, V-shaped twists) and dissection of the vertebral artery. Color duplex scanning allowed estimating of local and system hemodynamic significance of extravasal influences. The strategy of treatment and volume of surgical interference were defined by the degree of circulatory disturbance in the vertebral artery.

[The srategy of programed multistage surgical treatment ("damage control surgery") of neurotrauma].

A retrospective analysis of diagnostics and surgical treatment was made in 440 patients with polytrauma, who were on the treatment in hospitals in Saint-Petersburg, Syktyvkar and Omsk during 2009-2012. The neurotrauma was the dominating damage. The patients were divided into two groups: the main and the control group, using the equal quantitative ratio according to the sex, age, circumstances of trauma and type of damages. The strategy of programmed multistage surgical treatment ("damage control surgery") was used in the main group (220 patients, average age 31.7 +/- 5.2 years). The traditional strategy of treatment was applied in the control group (220 patients, average age 30.7 +/- 5.4 years). The damage control surgery allows the reduction of lethality in neurotrauma by 15.0% and improvement of social adaptation of patients by 12.7%.

[Algorithm of diagnostics and surgery of trauma and degenerative diseases of cervical spine].

A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31 +/- 5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52 +/- 7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed.

[Algorithm of the diagnostics of trauma and degenerative diseases of the spine].

Clinico-radial data were compared in 583 patients with trauma and degenerative diseases of the spine. The clinico-diagnostic complex included radiography of the spine (round-up and functional), magnetic resonance imaging, computerized helical tomography of the spine with spondylometric measurements. Indices of the measurements of the cross-section area of the vertebral artery canal at the level of C3-C6 vertebrae and the volume of the intervertebral canal at different levels in health among men and women are presented. An algorithm of radiation diagnostics in pathology of the spine is proposed.

[Assessment of surgical correction of parameters of the vertebral-motor segment in traumas and degenerative diseases of the vertebral column].

Retrospective clinico-radial data obtained in 163 patients were compared with traumas and degenerative diseases of the vertebral column of those who were treated by decompressive and decompressive-stabilizing interventions. Characteristic alterations were determined such as considerably decreased area of the spinal canal (in 44.2% of the patients), intervertebral foramen (in 57.7%) and the volume of intervertebral canal (in 66.3%), which allowed specification of the character and volume of the operative interventions and objective assessment of adequacy of surgical correction.

[The role of duplex scanning in diagnosing extravasal compression of vertebral arteries in degenerative diseases of the cervical part of the spine].

The method of duplex scanning was used in examination of 210 patients with degenerative-dystrophic diseases of the cervical part of the spine. It allows quantitative and qualitative assessment of the local and systemic hemodynamic value of extravasal compression of vertebral arteries. Local hemodynamic shifts in the area of extravasal influences on the artery were detected in 72.9% of the patients: decreased indices of blood flow and increased indices of peripheral resistance proximal to the compression zone, growing blood velocity in the area of the artery course deformity, in the place of its lumen constriction, decreased blood flow indices and indices of peripheral resistance distally to the compression zone. The assessment of blood flow in the vertebral arteries allows determination of the strategy of treatment of patients with degenerative-dystrophic diseases of the cervical part of the spine.

[The diagnostics and treatment of pain syndrome after operation for hernias of the intervertebral discs of the lumbosacral area of the backbone].

The results of treatment of 42 patients after eradication of hernias of intervertebral discs of the lumbosacral area of the spine with a recurrent pain syndrome were analyzed within the period from 2 months to 3 years after surgery. Almost all the patients were found to have a combination of two or more factors, responsible for the development of pain syndrome. Lumbostenosis and spondiloarthrosis were noted more often. Complex and specially directed medical actions allow getting regress of the pain syndrome and stable remission in 69% of the patients.

[Minimally invasive surgery of degenerative diseases of the spine].

Results of minimally invasive surgical treatment were studied in 978 patients with degenerative diseases of the spine. Paracentetic interventions were made on different structures of the spinal-motor segment after complex clinico-radial examinations. Catamnestic investigations during 3 years allowed detection of sufficiently stable positive effect of fenestration and decompression of the intervertebral disk (71%), dereception of different structures (64.1%), high-frequency electrodestruction (67.1%) and laser influence on them (78.4%).

[Alternative ways of collateral venous flow in occlusion of superior sagittal sinus].

The authors demonstrated alternative ways of bloodflow from occluded superior sagittal sinus through hypertrophic dural veins (middle meningeal veins) and sphenoparietal sinus. Parameters of bloodflow were evaluated using triplex ultrasonography. The possibility of venous drainage into anterior segment of superior sagittal sinus proximal to the site of occlusion with further retrograde flow towards dural venous anastomosis is verified. Possibilities of spiral CT-venography and standard time-of-flight MR-venography for assessment of collateral venous flow were estimated.

[Use of a diode laser in surgery of intervertebral disks in osteochondrosis of the vertebral column].

The results of surgical treatment of 185 patients with osteochondrosis of the vertebral column were studied during 12 months who, after complex clinico-radial examination, were treated by puncture laser nucleoplasty of intervertebral disks using a diode laser. Stable positive effect was obtained in 84.3% of cases using minimally invasive manipulations.

[The complex preoperative examination of children with a meningocele of the lumbosacral region]. / Predoperatsionnoe kompleksnoe obsledovanie detei so spinnomozgovoi gryzhei poiasnichno-kresttsovoi oblasti.

The article presents results of complex examinations of 50 children with meningocele of lumbosacral localization. All these patients were operated upon. The operation was preceded by clinical, electroencephalographic and X-ray examinations. Special attention was given to the degree of injuries of the caudal portions of the spinal cord and ist roots, to findings of spondylography, myelography with roentgen-negative and roentgen-positive contrast substances, pneumoencephalography and EEG.

[The complex x-ray examination of patients with myeloceles of the lumbosacral spine]. / Kompleksnoe rentgenologicheskoe obsledovanie bol'nykh so spinnomozgovymi gryzhami poiasnichno-kresttsovogo otdela pozvonochnika.

The authors analysed the results of complex radiologic examination of 46 patients who underwent operation for meningomyelocele (survey spondylograms and tomograms, pneumoencephalography and myelography with omnipac). Double positive-negative contrast study of the subarachnoid space on the level of the meningomyelocele as well as the hernial sac allows authentic judgement on the degree of disorders in the spine, hernial sac, and the c.s.f. system.