[Results of surgical treatment of children with Chiari I malformation using differentiated intraoperative tactics of choosing the volume of intervention]. / Rezul'taty khirurgicheskogo lecheniya detei s mal'formatsiei Kiari I tipa pri primenenii differentsirovannoi intraoperatsionnoi taktiki vybora ob"ema vmeshatel'stva.

BACKGROUND: Despite the presence of numerous publications and analytical reviews in the foreign literature, there is no universally accepted algorithm for the surgical treatment of Chiari I malformation (MC I) in children. Moreover, in the domestic literature, the number of publications devoted to the problems of surgical treatment of MC I in children is significantly limited, which, in our opinion, this is the reason for the relevance of this work. OBJECTIVE: To study the results of surgical treatment of children with MC I when applying differentiated tactics of intraoperative choice of intervention volume. MATERIAL AND METHODS: The results of neurological examination and surgical treatment of 43 patients aged from 1 to 17 years (mean age 8.48 years) were analyzed. The decision on the need for duraplasty was made intraoperatively when signs of persisting compression of subarachnoid spaces after extradural decompression were detected. Clinical manifestations were assessed according to neurological data before discharge, as well as in long-term period with a follow-up from 6 months to 5 years via survey. RESULTS: Duraplasty was required in 28% of cases. Respiratory disorders disappeared in all patients immediately after surgery and were absent thereafter. Positive dynamics was noted in terms of restoration of the rate of speech development. Headache persisted in 7 (21%) patients, movement, sensation disorders and cerebellar symptoms - in 4 (12%), vomiting and bulbar symptoms - in 2 (6%) patients. There was no difference in the efficacy of surgery with and without duraplasty. None of the parameters evaluated preoperatively had a significant association with the intraoperative decision on the need for duraplasty. CONCLUSION: In our opinion, final decision on surgical strategy in children with Chiari malformation type I should be made considering intraoperative assessment of extradural decompression. The last one is probably associated with individual characteristics of patients.

[Arteriovenous malformations and epileptic seizures in children: risk factors of seizures and efficacy of their control depending on the surgical treatment modality]. / Arteriovenoznye mal'formatsii i épilepticheskie pristupy u detei: faktory riska razvitiia pristupov i éffektivnost' ikh kontrolia v zavisimosti ot metoda khirurgicheskogo lecheniia.

Epileptic seizures are some of the most frequent manifestations of cerebral AVMs in children. Poor control of seizures can significantly affect patients' quality of life. In this case, factors that are associated with the development of seizures and affect the efficacy of their control upon treatment of cerebral AVMs are not well understood. PURPOSE: The purpose of this study was to identify risk factors for the development of epileptic seizures as well as factors associated with a seizure-free outcome of AVM treatment in children. MATERIAL AND METHODS: We analyzed the results of examination and treatment in 89 patients with cerebral AVMs aged 1 to 17 years. RESULTS: Factors associated with the development of epileptic seizures in cerebral AVMs in children included male gender of the child, a large size of AVM and its superficial location, as well as localization of the pathology in the frontal and temporal lobes of the brain and draining varices. Regression of seizures after surgery was more often observed in the case of microsurgical and/or complex surgical treatment and complete exclusion of the AVM as well as in cases of rare attacks and a short course of the disease. CONCLUSION: Complex and microsurgical treatment of AVMs in children provides effective control of epileptic seizures, which is obviously associated with complete exclusion of the AVM and removal of the epileptic focus located near the AVM.

[The effect of spinal cord stretching on development of spondylogenic cervical myelopathy associated with kyphotic spinal deformity]. / Znachenie rastiazheniia spinnogo mozga v formirovanii spondilogennoi tservikal'noi mielopatii na fone kifoticheskoi deformatsii pozvonochnika.

OBJECTIVE: The study objective was to specify the role of spinal cord stretching in the pathogenesis of spondylogenic cervical myelopathy associated with kyphotic spinal deformity. MATERIAL AND METHODS: We analyzed long-term outcomes of surgical treatment for spondylogenic cervical myelopathy accompanied by kyphotic spinal deformity. RESULTS: The surgical treatment outcomes were significantly better (p<0.000001) in the case of simultaneous decompression/correction of kyphotic deformity and spine stabilization. CONCLUSION: Spinal cord stretching associated with kyphotic spinal deformity significantly contributes to the pathogenesis of clinical manifestations of spondylogenic cervical myelopathy.

[Surgical treatment outcomes in children with tethered spinal cord syndrome. A prognosis on the basis of spinal 3T MRI tractography]. / Rezul'taty khirurgicheskogo lecheniya detei s sindromom fiksirovannogo spinnogo mozga. Prognoz na osnovanii dannykh spinal'noi 3Tl MRT-traktografii.

AIM: The study objective was to identify factors affecting surgical treatment outcomes in children with tethered cord syndrome (TCS). MATERIAL AND METHODS: The study included 21 TCS patients aged 1 to 14 years who underwent tethered cord release. The preoperative and postoperative data of clinical and neurophysiological examination and high field (3T) MRI tractography of the caudal spinal cord were compared. RESULTS: Regression of the TCS clinical and electrophysiological signs and the lack of pathological changes in the spinal cord tracts were observed in patients with filum terminale abnormalities and caudal lipomas after surgery. In patients with secondary spinal cord tethering caused by scar formation after lumbosacral myelomeningocele repair, a motor deficit was related to the interruption level of the spinal tracts, and surgical treatment did not lead to significant regression of the TCS clinical and electrophysiological signs. CONCLUSION: We consider the absence of pathological changes in the caudal spinal cord, based on spinal MRI tractography, as a favorable prognostic factor in TCS surgical treatment.