ABSTRACT
OBJECTIVE: To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes. RESULTS: The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021. CONCLUSION: Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.
Subject(s)
Aneurysm, Ruptured , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Subarachnoid Hemorrhage , Humans , Intracranial Aneurysm/surgery , Pandemics , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Treatment Outcome , Embolization, Therapeutic/methods , Aneurysm, Ruptured/surgery , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Subarachnoid Hemorrhage/surgery , Retrospective StudiesABSTRACT
BACKGROUND: Intraoperative control of optic nerve function conservation during neurosurgical operations currently relies mainly on visual evoked potential monitoring. Unfortunately, this detects peril only when the visual pathways are already compromised, sometimes irreversibly. In contrast, electrophysiological stimulation mapping of the nerves can be a fully preventive measure. However, direct sensory nerve mapping requires the patient to be awake during surgery, which is unfeasible for surgeries targeting the optic nerve area. Another possible approach to sensory nerve mapping involves unconditioned electrophysiological responses evoked by sensory nerve stimulation. The key point for this approach is the possibility of obtaining such responses for a particular sensory nerve under surgical anesthesia. CASE REPORT: A 52-year-old woman presented with meningioma in the area of right optic nerve and chiasm. She underwent microsurgical removal of the tumor through the transciliary supraorbital approach. During surgery, electrodes at the inferior margin of the right orbit repeatedly recorded electrophysiological reactions following contacts and displacements of the right optic nerve by the surgical instruments. CONCLUSIONS: The observed reactions suggest that either the unconditioned blink reflex or antidromic electroretinographic response to optic nerve irritation was conserved under total intravenous anesthesia. This observation might be of value for development of intraoperative optic nerve mapping. This in turn could increase patient safety by identifying the exact optic nerve location before any negative impact on it.
Subject(s)
Meningeal Neoplasms , Meningioma , Evoked Potentials, Visual , Female , Humans , Meningioma/surgery , Middle Aged , Optic Nerve/surgery , Visual PathwaysABSTRACT
We studied the effect of erythropoietin on functional properties of mesenchymal stem cells under conditions of oxidative stress and their therapeutic potential in the treatment of intervertebral disc degeneration in Wistar rats. It was shown that erythropoietin stimulates proliferation under conditions of oxidative stress. Injection of bone marrow mesenchymal stem cells into the damaged intervertebral disc was followed by an increase in the height of the intervertebral disc and activation of repair processes in the nucleus pulposus. The combination of mesenchymal stem cells with erythropoietin provides the best effect of cell therapy in case of intervertebral disc damage.
Subject(s)
Bone Marrow Cells/drug effects , Erythropoietin/pharmacology , Intervertebral Disc Degeneration/therapy , Intervertebral Disc/drug effects , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/drug effects , Animals , Bone Marrow Cells/cytology , Bone Marrow Cells/metabolism , Cell Proliferation/drug effects , Disease Models, Animal , Femur/cytology , Humans , Hydrogen Peroxide/antagonists & inhibitors , Hydrogen Peroxide/pharmacology , Injections, Intralesional , Intervertebral Disc/injuries , Intervertebral Disc/metabolism , Intervertebral Disc Degeneration/metabolism , Intervertebral Disc Degeneration/pathology , Male , Mesenchymal Stem Cells/cytology , Mesenchymal Stem Cells/metabolism , Oxidative Stress , Rats , Rats, WistarABSTRACT
A retrospective cohort analysis of the results of treatment of patients with malignant gliomas was made in 2 groups, each comprising 43 patients. In Group 1, the tumors were radically removed under neuronavigation guidance ("Voyager SX"). In Group 2 where the patients were operated on by the same team of surgeons who did not employ computer-assisted navigation technologies. The results of different adjuvant therapy regimens were analyzed in patients after radical tumor removal under navigation guidance (Group 1). In its first subgroup, 24 patients with anaplastic astrocytes were postoperatively irradiated (60 Gy), followed by treatment with temodal (200 mg/m2 (mean 6 courses). In the second subgroup, 12 patients received chemoradiotherapy (temodal, 75 mg/m2 daily + irradiation), followed by courses (n=6) of temodal, 200 mg/m2). In the third subgroup, 7 patients were treated with fotemustin (200 mg/m2 (induction) + 5 cycles). The computer-assisted technologies substantially improve a postoperative outcome in patients with malignant glionas. Current chemoradiotherapy is relatively safe and prolongs a relapse-free interval with a high quality of life. Further studies call for the efficiency of different adjuvant therapy regimens after radical surgery.