[Modification of intercostobrachial neurotization of musculocutaneous and axillary nerves in total brachial plexopathy: description of technique and literature review]. / Modifikatsiya interkostobrakhial'noi nevrotizatsii myshechno-kozhnogo i podmyshechnogo nervov pri total'noi brakhiopleksopatii: opisanie metodiki i obzor literatury.

BACKGROUND: Intercostobrachial neurotization is one of the few approach for partial motor recovery of extremity in patients with total trauma of brachial plexus. However, direct coaptation with musculocutaneous nerve is often impossible due to different anatomy of intercostal nerves and their functional failure at several levels. This necessitates the use of intermediate graft that deteriorates the final outcome. OBJECTIVE: To develop an alternative method for direct coaptation of musculocutaneous nerve with insufficiently long intercostal donor nerves. MATERIAL AND METHODS: The study included 26 patients with total post-traumatic plexitis. All patients underwent intercostobrachial neurotization of musculocutaneous and axillary nerves. Original technique of direct selective neurotization of motor fascicular groups of musculocutaneous and axillary nerves was used in 11 cases. RESULTS AND DISCUSSION: A modified variant of intercostobrachial neurotization of musculocutaneous and axillary nerves consists in mobilization and transposition of recipient nerves in axillary region. This makes it possible to reduce the distance to donor nerves and, in most cases, to carry out direct neurotization without autologous grafts. Among 11 patients, restoration of shoulder abduction and elbow flexion was obtained in 7 patients (77 %). CONCLUSION: The proposed adaptive technique makes it possible to avoid graft lengthening in some cases and provides satisfactory results.

[Diagnosis and treatment of paralysis following intrafascicular peripheral nerve torsion: two clinical observations and a literature review]. / Diagnostika i lechenie paralicha, vyzvannogo intrafastsikulyarnym perekrutom perifericheskogo nerva: dva klinicheskikh nablyudeniya i obzor literatury.

BACKGROUND: Intrafascicular nerve torsion is a rare and poorly studied type of nerve compression. This disease can be assigned to compression-induced neuropathies, but it has a distinctive feature. It is a spontaneous intrafascicular compression following internal local spiral deformation and compression of the nerve outside routine tunnels due to its torsion around its own axis. Understanding the pathogenesis of such spiral compression is essential in diagnosis, prognosis and treatment of these patients. OBJECTIVE: To assess the effectiveness of various diagnostic techniques, the possibility and effectiveness of surgical treatment of patients with spiral intrafascicular nerve deformation. MATERIAL AND METHODS: The authors report 2 patients (45-year-old man and 38-year-old woman) who were examined for progressive radial neuropathy of unknown etiology. Ultrasound of the radial nerve and electroneuromyography were performed. These data made it possible to diagnose nerve lesion in both cases. These findings justified external and internal radial nerve decompression. RESULTS: Ultrasound was valuable to establish localization and cause of radial nerve lesion (local hourglass-shaped deformation). Electroneuromyography confirmed conduction disturbances along the altered segment of radial nerve in both patients. Intraoperatively, intrafascicular nerve torsion as a cause of functional disorders was confirmed in both cases. Both patients required external and internal nerve decompression with restoration of linear orientation of the nerve and its fixation within the epineurium. Positive effect was noted immediately after surgery. Control survey after 3 and 6 months revealed significant regression of symptoms (increase in muscle strength and motion amplitude) and high satisfaction with treatment outcomes. CONCLUSION: Clinical manifestations of intrafascicular radial nerve torsion imitate typical compression-induced neuropathy. However, this lesion is characterized by another unclear pathogenesis, localization far from natural tunnels, typical ultrasound and intraoperative patterns. Surgical treatment has certain features, and its effectiveness depends on surgical technique and ranges from 60% to 90%.

[Working results of the electronic "on-line" version of the Spine Registry for Degenerative Lumbar Spine Diseases and study of its synchronization capacity with the electronic case history]. / Itogi raboty portal'noi versii poiasnichnogo vertebrologicheskogo registra i izuchenie voprosa ego sinkhronizatsii s élektronnoi istoriei bolezni.

AIM: To assess the results of use of lumbar spine on-line registry in 2012 (IV quarter). MATERIAL AND METHODS: The Burdenko Neurosurgery Institute of the Russian Academy of Medical Sciences (RAMS) and the System Analysis Institute of the Russian Academy of Sciences (RAS) have developed an electronic "on-line" portal of the Spine Registry for Degenerative Lumbar Spine Diseases. The data on 1295 retrospective and 145 prospective patients who underwent treatment in Burdenko Neurosurgery Institute, the "AXIS" clinic, Medical Centre of the Bank of Russia, "Marina Spine Clinic" LA, USA and in the Neurosurgery department of Research Institute of Traumatology and Orthopedics, Nizhny Novgorod were analyzed. Since May 2012 to the present time outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, which underwent treatment from 2002 to 2012 were entered into online registry and subsequently analyzed. The current study has revealed two problems that need to be discussed. First problem is that the archived information is not sufficient for data base update. The second problem is low activity of many physicians in inputting data into the register. We believe that the solution of these problems lies in the plane of synchronization of on-line registry with electronic medical records. This synchronization between registry and online records will allow studying their joint work. If found to be successful after the development of the other sections of the register they will be added to an already running version as provided by the principles of its work - scalability and extesibility. The results of this work will be profile of vertebrological version of electronic medical records. In the future it could be used in clinics dealing with spine disorders. RESULTS: Since May 2012 the outcomes of 1295 (retrospective group) and 145 (prospective group) patients with Degenerative Lumbar Spine Diseases, who were operated on in Burdenko Neurosurgery Institute (Moscow, Russia), minimally invasive spinal surgery clinic "AXIS" (Moscow, Russia), Medical Centre of The Bank of Russia (Moscow, Russia), "Marina Spine Clinic" (LA, USA) and Neurosurgery department of Research Institute of Traumatology and Orthopedics (Nizhny Novgorod, Russia) from 2002 to 2012 were analyzed. The perspective of this work is development of other parts of spine registry (for cervical and thoracic spine) and improving the outcome assessment process in Russian spinal surgery clinics.

[The use of computed tomography in stereotaxic operations in dyskinesia patients]. / Primenenie komp'iuternoi tomografii pri stereotaksicheskikh operatsiiakh u bol'nykh s diskineziiami.

Experience with 366 CT-stereotactic operations in varying movement disorders (Parkinson's disease, cerebral palsy, torsion dystonia, torticollis, hemihyperkinesis) is presented. Different deep structures, such as thalamic nuclei, subthalamic structures, palladium, putamen, caudate nucleus, dentate nucleus, and brachium conjunctivum or combination of these structures, were selected as a stereotactic target point. Anodic or radiofrequency stimulation, implantation of chronic intracerebral electrodes and neurotransplantation were used as methods of exposure. A procedure for CT-stereotactic determination of supratentorial and subtentorial target points is described. CT-guided stereotactic procedures in the treatment of dyskinesia are precise and less traumatic than ventriculography-guided procedures.

[Stereotaxic resection of intracerebral tumors]. / Stereotaksicheskaia rezektsiia vnutrimozgovykh opukholei.

Stereotactic computerized technology providing a goal-oriented and low-traumatic access to small intracerebral tumors and their precision microsurgical removal has been developed. A specialized programme implemented on an IBM PC/AT makes a whole set of stereotactic calculations based on computerized tomography (CT). With this, a three-dimensional volumetric tumor reconstruction is conducted by interpolating the tumor outlines which can be seen on consecutive stereotactic CT sections. The system provides laminar visualization of the tumor outlines in the distal aperture plane of an original tubular retractor which makes an access to the tumor and its removal and coincides these sections with the aperture projection. Thus, each discrete unit of tumor volume (minimum 1 cubic mm) proves to be stereotactically oriented against the retractor both in the plane of its aperture and along its trajectory. Examining the images prio and during surgery simulates an operational field, thus computerally supporting the resection of a tumor strictly in the range of CT-defined outlines. A total of 15 patients aged 3 to 52 years who had hemispheric tumors were treated. Five patients presented with cancer metastases (one of them had multiple ones), 7 had gliomas and 1 displayed a radiation necrotic focus at the site of the irradiated glial tumor that was verified by stereotactic biopsy, 2 cases had cavernous angiomas. The use of stereotactic techniques for tumor removal in these patients was determined by their location and small sizes. Eight cases presented with in-depth tumors located in the area of subcortical ganglions, the visual tuber, and the internal bursa. In 7 patients there were a comparatively superficial tumors afflicting the cortex and substantia alba in the projection of central gyri or temporoparietal regions in the predominant hemisphere. The maximum dimensions of tumors varied 10 to 35 mm without exceeding 25 mm in most (14) patients. A small circulatory trephination with a crown cutter, 35 mm in diameter, was employed in the majority of cases (in 13 patients). In 3 cases, there was a slight and transient aggravation of the existing focal symptomatology followed by regression and return to the preoperative values during 5-6 days. Following surgery, 10 had either improved status or no additional iatrogenic defect or they underwent outpatient treatment within 6-7 days after intervention. In 2 cases, a steady-state aggravation of focal symptoms was associated with surgery. Control studies by CT and MRT provided evidence for no residual tumor tissue in all cases except one.