[Endovascular surgery of spinal dural arteriovenous fistulas]. / Éndovaskuliarnaia khirurgiia dural'nykh arteriovenoznykh fistul spinnogo mozga.

The article summarizes the experience in the treatment of spinal dural arteriovenous fistulas (SDAVFs). OBJECTIVE: To evaluate the efficacy of endovascular treatment of SDAVFs, depending on the pathophysiological mechanisms of impact on the spinal cord. MATERIAL AND METHODS: For the last 5 years (2013-2017), 302 patients with SDAVFs were diagnosed and treated at the Neurosurgical Institute. The endovascular technique was used in 295 patients with this pathology. Males accounted for 82%; females accounted for 18%; the mean age was 51 years. Magnetic resonance imaging (MRI) was used to assess the degree of spinal cord involvement. All SDAVF patients underwent total selective spinal angiography in order to study angioarchitectonics and to choose an endovascular treatment option. RESULTS AND CONCLUSION: Endovascular embolization of fistulas was performed in 295 out of 302 patients; direct surgery was used in the remaining cases. Endovascular treatment provided total SDAVF occlusion in 78% of cases and partial SDAVF occlusion in 22% of cases. Long-term outcomes were followed-up in all patients in a period of 6 to 12 months. In 90% of cases, improvement or stabilization of neurological symptoms was observed. In 60% of cases, there was a marked improvement in the neurological status in the form of rapid (within a few days) recovery of lost motor functions. The remaining patients had stabilization of clinical symptoms.

[The history of surgery for brain and spinal cord vascular pathology at the Burdenko Neurosurgical Institute (to the 50th anniversary of foundation of the First Neurovascular Department)]. / Istoriya khirurgii sosudistoi patologii golovnogo i spinnogo mozga v Institute neirokhirurgii im. akad. N.N. Burdenko (k 50-letiyu osnovaniya pervogo neirososudistogo otdeleniya).

The Vascular Department of the Burdenko Neurosurgical Institute is one of the country's first dedicated departments engaged in treatment of patients with cerebrovascular diseases. The modern vascular service of the Institute is represented by several departments and groups: the Department of Microsurgical Treatment of Vascular Diseases, a group of Reconstructive Brachiocephalic Surgery, and the Department of Endovascular Surgery and Neurodiagnosis that is also engaged in intra-arterial chemotherapy and angiographic diagnosis. The neurovascular service of the Institute is a rightful leader of Russia in the number operations and their complexity: patients with the most serious and unusual pathologies are referred to the Institute from across the country. The achievements of the service are based on science and clinical practice that underlie progressive improvement in the diagnosis, surgical methodology, and recovery of neurovascular patients. On November 02, 2016, the Vascular Department of the Burdenko Neurosurgical Institute will celebrate the 50th anniversary of its foundation.

[PREDICTING, POSSIBLE WAYS TO REDUCE AND CORRECTION OF MASSIVE INTRAOPERATIVE BLOOD LOSS IN SPINAL TUMOR SURGERY].

The paper discusses the problem ofpredicting, prevention and therapy of massive intraoperative blood loss in patients with metastasis in spine and spinal cord. We analyze 60 surgical cases in last 14 years in our clinic. Amount of blood loss was more that 80% of total blood volume in each case (from 2.5 to 17 liters). Preoperative selective angiography data on intensity of tumor blood supply were essential for blood loss prediction. Simultaneous embolization oftumor during angiography dramatically reduced intraoperative blood loss. Combination of blood saving techniques (preoperative autodonation, acute normovolemic hemodilution and intraoperative cell salvage) led to effective compensation of blood volume deficit and minimizing of allogenic blood transfusion. Plasma-derived and recombinant factors were effective in management of hemostatic disorders associated with massive blood loss.

[Surgical treatment of cerebral vascular diseases].

Theoretical and practical aspects of the complex treatment of brain and spinal vascular diseases using microsurgical, endovascular and radiosurgical methods are considered. Authors present the data demonstrating that, due to the implementation of the program of development of vascular centers in the Russian Federation, considerable progress was made in the treatment of cerebral aneurisms and hemorrhagic stroke. In author's opinion, wide introduction of surgical methods in the treatment of occlusive lesions of the blood vessels supplying the brain is needed.

[CyberKnife stereotactic radiotherapy for mass lesions of the spinal cord and spine].

Introduction of a novel technology of stereotactic radiation treatment using linear accelerators, refining of systems for visualization and guidance provided rapid development of extracranial radiosurgery. Nowadays there is a possibility of precise stereotactic irradiation of lesions with different size and localization. One of the most actual and promising indications for radiosurgery are different primary and metastatic lesions and arteriovenous malformations of spinal cord and spine. Radiosurgery and hypofractionated radiotherapy with precise dose delivery during one or several sessions allow effective and safe treatment of neoplasms with any degree of radioresistance. This paper contains analysis of the first Russian experience of stereotactic radiation treatment of lesions of spinal cord and spine using robotized system CyberKnife (Accuray Inc., USA).

[Noninvasive magnetic resonance myelography in patients with lumbosacral intervertebral disk herniation].

For many decades X-ray myelography has remained one of the major diagnostic methods for spinal pathology. With the advent of computed tomography (CT), CT myelography using water-soluble contrast agents has been developed. Visualization of the subarachnoidal spaces of the spinal cord and dural sac without an intrathecal contrast agent has become possible with the emergence of magnetic resonance imaging (MRI). Its further development and improvement has brought to existence the new noninvasive technique MR myelography based on the suppression of a signal from the medulla and its enhancement from the cerebrospinal fluid-containing spaces. This paper compares routine X-ray myelography, CT myelography, and MR myelography used in the diagnosis of lumbosacral intervertebral disk herniation and assesses the informative value and benefits of MR myelography as a noninvasive diagnostic method for this pathology.

[Spontaneous anterior meningeal arterial aneurysmal rupture].

The paper describes a rare case of a patient with spontaneous rupture of nontraumatic anterior meningeal arterial aneurysmal rupture. The patient underwent clipping of the neck of the aneurysm and its excision. A detailed account of intraoperative signs of this aneurysm is given. Angiographic and morphological data and the morphological pattern confirming the true pattern of the aneurysm are presented.

[Stent-graft use in endovascular neurosurgery].

The authors describe 2 clinical observations of the use of stent-grafts (polymer film-covered stents) in endovascular neurosurgery. In one case, a stent-graft was used to perform a reparative endovascular operation for the carotid-cavernous fistula; in the other the vertebral artery was stented at the origin of an afferent vessel of arteriovenous malformation of the spinal cord. The prospects for using endovascular prostheses in the surgery of extra- and intracranial vessels are discussed.

[Rupture of the dissecting vertebral arterial aneurysm].

The paper describes a rare case of a patient with dissecting vertebral arterial aneurysmal rupture. The patient was operated on--the aneurysmal wall was reinforced with surgical gauze. The intraoperative signs of the dissecting aneurysm are described in detail. The angiographic signs of dissecting aneurysms are given.

[Vertebroplasty in the treatment of spinal diseases]. / Vertebroplastika pri lechenii zabolevanii pozvonochnika.

The results of surgical treatment by vertebroplasty are analyzed in 28 patients with different spinal diseases. A procedure for percutaneous vertebroplasty with polymethyl methacarylate is presented. This miniinvasive method has been shown to be highly effective in treating vertebral hemangiomas, osteoporotic compression fractures, and vertebral metastases and in strengthening the anterior vertebral column as compared with anterior spondylosis in open surgical operations.

[Posterio-median approach in ventral tumor compression of the spinal cord]. / Zadnesredinnyi dostup pri ventral'noi opukholevoi kompressii spinnogo mozga.

The paper describes two types of resection of primary and metastatic spinal tumors via a posterolateral approach: by curettage and en-block resection. The outcomes of treatment in 15 patients operated on by curettage and 2 patients undergone en-block resection are analyzed. Postoperative pain relief was noted in 100% of the patients. Six (55%) patients who had not been able to move became outpatient after surgery. There was a neurological improvement in 5 (29%) patients, i.e. they were at a higher stage by the Frankel scale. The above results show that removal of spinal tumors via posteriomedian access with lateral extension by curettage or en-block resection might be effective in surgically treating this pathology. Choice of a type of surgery (carcinological or palliative) primarily depends on the histological nature of a tumor, on the degree of neurological deterioration, on the extent and site of a tumorous process, and on the expected survival of a patient.

[Use of different endovascular treatments for arteriovenous malformations of the spinal cord]. / Primenenie razlichnykh éndovasculiarnykh metodov lecheniia arteriovenoznykh mal'formatsii spinnogo mozga.

The paper presents outcomes of treatment of patients with arteriovenous malformations (AVM) of the spinal cord by using endovascular techniques in 171 patients. There were a total of 364 occluded afferent vessels involved in the blood supply to and development of AVM. A classification of spinal cord AVM is presented. Methods for occlusion were described in relation to the type AVM. Malformations were thrombosed with polyvinyl acetate (PVA) emboli in 129 patients; balloon occlusion of afferent vessels was performed in 6, as described by F. A. Serbinenko; histoacryl glue was applied in 27 cases. A combined method of occlusion of afferent vessels was used with PVA emboli and balloons in 9 patients. The clinical picture of spinal cord AVM was outlined. Emphasis is laid on diagnostic methods, such as selective angiography and magnetic resonance imaging, as well as on their role in postoperative control studies, in determining the degree of thrombosis, the presence of ischemic events, and subarachnoidal space patency. Endovascular treatment used in patients with AVM at different levels of the spinal cord alleviated neurological symptoms in 155 (91%) patients. There was no improvement in 12 (7%) patients. Complications at angiography and embolization were observed with deteriorated neurological symptoms in 4 (2%) cases. Further development and improvement of endovascular treatments in patients with spinal cord will be promising if new intervention technologies are introduced in clinical practice.

[Microsurgical treatment of compression of the rear wall of the spinal artery in intervertebral arthrosis]. / Mikrokhirurgicheskoe lechenie komprssii zadnei stenki pozvonochnoi arterii pri artroze mezhpozvonkovykh sustavov.

Vertebral artery stenosis caused by cervical spondylosis is generally caused by compression of the artery by osteophytes arising from an uncinate process. Compression caused by facet joint osteophytes is rarely reported. The paper shows that compression may also occur posteriorly by osteophytes from the facet complex. Careful evaluation of preoperative angiograms and computed tomographic or MRI scans is required to determine whether an anterolateral, posteriorlateral or posterior approach might be more beneficial for decompression.

[The validation of a procedure for the surgical treatment of intervertebral disk hernias of the cervical spine]. / Obosnovanie taktiki khirurgicheskogo lecheniia gryzh mezhpozvonokovykh diskov sheinogo otdela pozvonochnika.

Thirty-four consecutive patients with cervical disc herniation underwent surgical treatment at Burdenko Neurosurgical Institute. The clinical signs and diagnostic findings as well as surgical results were analyzed. Predominance of direct spinal cord involvement, characteristic changes in the anterior spinal artery and afferent vessels confirm the fact that cervical disk herniation causes vascular changes to take place, which in turn affect neural structures. Microsurgical techniques with maximum preservation of bone structures and vertebral endplates is mandatory. If multiple disk herniations are present, the most prominent compressing disk fragment should be removed. Stabilization following the surgery is considered effective.

[The comparative characteristics of the otoneurological disorders and of the computed and magnetic resonance tomographic data in tumors of the pineal area]. / Sravnitel'naia kharakteristika otonevrologicheskikh narushenii i dannykh komp'iuternoi i magnitno-rezonansnoi tomografii pri opukholiakh pineal'noi oblasti.

A hundred and twenty patients with pineal tumors were examined and analyzed. All the patients underwent detailed otoneurological examination supplemented by vocal and tone audiometry, electronystagmography. Computerized tomography (CT) with contrast reinforcement was made in all the patients. Magnetic resonance imaging (MRI) was conducted in 43 patients. Based on the findings, otoneurological symptomatology and CT and MRI data were compared. All the patients were divided into 4 groups by the size of a tumor and by the magnitude of its impact, as evidenced by CT and MRI. Comparing the findings, it can be concluded that with larger pineal tumors and the increased decompensation of a process there is a steady rise in the incidence of some otoneurological symptoms. Nevertheless, there is a clear relationship of otoneurological manifestations to the predominant growth of pineal tumors into the diencephalic area or into the posterior cranial fossa, by affecting truncal cochleovestibular formations and tumor sizes.

[The structure and hemodynamics of arteriovenous malformations of the spinal cord]. / Stroenie i gemodinamika arteriovenoznykh mal'formatsii spinnogo mozga.

The structure and hemodynamics of arteriovenous malformations of the spinal marrow are first described in the Russian literature on the basis of 93 cases with spinal marrow arteriovenous aneurysms (SMAA) verified by selective spinal angiography. The angiographic pattern of SMAA (their site, blood supply, and ways of outflow) is given in detail. Analysis and clinical tests made it clear that 80% of the patients had subarachnoidal hemorrhage and 60% had recurrent and multiple hemorrhage. Prior to angiography 35 patients had undergone myelography with water soluble contrast agents and 42 had magnetic resonance imaging. Combined vascular lesions in the spinal marrow and other organs were revealed in 20% of the patients. The malformations were divided into 4 types by the angiographic findings of their structure and hemodynamic parameters.

[The prognosis of the ischemic complications due to a cerebral arterial spasm after subarachnoid hemorrhages (clinico-dopplerographic comparisons)]. / Prognozirovanie ishemicheskikh oslozhnenii, obuslovlennykh tserebral'nym arterial'nym spazmom posle subarakhnoidal'nykh krovoizliianii (kliniko-dopplerograficheskie sopostavleniia).

The clinical status, angiographic and Doppler ultrasound transcranial findings were compared in 50 patients with acute subarachnoidal hemorrhage (40 with aneurysmal hemorrhage and 10 with unknown hemorrhage). There was a correlation between the change in the linear velocity of blood flow in the cerebral arteries and the clinical manifestations of arterial spasm-induced brain ischemia. With this, Doppler signs of arterial spasm appeared as clinical manifestations 3-4 days earlier. The linear velocity of middle cerebral arterial blood flow, which is critical for the development of ischemic complications of arterial spasm was 295 +/- 6 cm/sec. The magnitude and duration of the excess critical level of the linear velocity of blood flow and the presence of arterial spasm in the contralateral hemisphere may determine whether the progressive ischemic symptoms are reversible or irreversible. A further course of arterial spasm, development of ischemic complications and their outcomes may be predicted by the increasing gradient of the linear velocity in the cerebral arteries at days 4-6 of subarachnoidal hemorrhage and the extent of spasm.

[The dynamics of the vestibulocochlear syndrome after the removal of tumors in the pineal area]. / Dinamika preddverno-ulitkovogo sindroma posle udaleniia opukholei pineal'noi oblasti.

The paper presents the follow-up data on 39 patients who underwent microsurgical removal of pineal tumors. Computerized and magnetic resonance tomographies were performed prior to and following the removal of pineal tumor. Otoneurological symptoms were analyzed in their dynamics in 32 patients in the early postoperative period (up to 20 days) and in 6 patients in the late period (1 to 5 years) after radiation therapy. Seven patients died from intracranial complications in the early postoperative period. Acoustic and vestibular functions were evaluated from otoneurological, electronystagmographic, pure-tone and verbal audiometric findings. The postoperative positive dynamics of acoustic and vestibular functions was observed in most patients. A steady-state positive effect also remained in 5 patients in the long-term period. The paper gives 2 cases with clear-cut positive cochlear dynamics after removing pineal tumors.