[Reduction cranioplasty for hydrocephalic macrocephaly: clinical observations and literature review]. / Reduktsionnaya kranioplastika pri makrotsefalii, vyzvannoi gidrotsefaliei: klinicheskie nablyudeniya i obzor literatury.

Reduction cranioplasty for extreme hydrocephalic macrocephaly is performed for acquiring motor skills (head holding, sitting, moving), aesthetic correction and social adaptation of children. The authors analyze literature data and describe 2 patients with congenital hydrocephalic macrocephaly who underwent shunting surgery followed by reduction cranioplasty in early age using resorbable mini-plates. Reduction cranioplasty decreased skull volume, improved social adaptation of children and ensured favorable aesthetic outcome.

[Experience of using neuroendoscopy in treatment of noncommunicating hydrocephalus in infants].

320 children were operated on for occlusive hydrocephalus for 10 years (2003-2012). Infant patients amounted to 93.4%, of these newborns were 29.2%. An endoscopic technique was used to restore physiological liquor circulation and compensate for hydrocephalus without shunt implantation. The positive outcome was observed in 75% of cases. Occlusion of the subarachnoid space occurred in the other cases, which required a combination of neuroendoscopic intervention and shunt implantation. There were no complications and mortality associated with an operative trauma.

[The state of the nasal cavity and paranasal sinuses in the children presenting with congenital cleft of upper lip and palate].

The objective of the present study was to evaluate the state of the nasal cavity and paranasal sinuses in the children presenting with congenital cleft of upper lip and palate (CLP). A total of 23 children at the age from 9 to 16 years who had undergone the surgical treatment of the above malformations during the first year of life were examined. The comprehensive study including routine ENT examination, endoscopic examination of the nasal cavity and nasopharynx, and computed tomography has demonstrated that 50% of the patients with congenital cleft of upper lift and palate suffered the deflection of the nasal septum associated with hyperplasia of inferior turbinal bones. The children with congenital cleft of upper lip and palate were characterized by enhanced pneumatization of the anterior end of the middle turbinate despite the absence of well apparent differences between their paranasal sinuses and those of the healthy children, with the degree of pneumatization being consistent with the patient's age in both groups.

[Application of expanders in surgical treatment of an infant with large myelomeningoradiculocele].

In the article authors describe application of expanders for effective closure of skin defect after surgical removal of large myelomeningoradiculocele in an infant.

[Dynamics of the otoscopic and audiologic picture in children with congenital isolated palatal clefts at different stages of surgical treatment].

This otoscopic study including tympanometry and the test for otoacoustic emission involved children since birth till the age of 1.5 years with an isolated grade II (n=16) and III (n=20) palatal cleft. The patients were examined before and at different stages of surgical treatment. Normalization of the otoscopic picture and functional capacity of the Eustachian tube was achieved in 70% of the children with congenital isolated palatal clefts due to the recovery of natural anatomic characteristics of palatal muscles following surgical intervention within the first year of life.

[Surgical treatment for anterior cerebral hernias].

The paper describes the authors' experience in treating 22 patients aged 2 months to 16 years who had congenital anterior cerebral hernias. A comprehensive principle that consists in removing hernial defects of the pachymeninx and skull base, excising herniation, and performing reconstructive operations in concomitant craniofacial deformities was used in the treatment of children with anterior encephalocele. All these surgical procedures were, if possible, performed in one step. There were no recurrent cerebral hernias and nasal liquorrhea was also absent. There was no progression of neurological symptoms in all patients. None patient developed meningitis or other infectious complications. All the parents recognized the cosmetic results of surgery as satisfactory. Three cases of different variants of this pathology are presented as an illustration of current surgical treatment.

[Clinical and roentgenological characteristics of synostosis frontal plagiocephaly, induced by early synostosis of cranio-cerebral sutures].

In this study authors demonstrate description and analysis of clinical and roentgenological presentations of early synostosis of cranio-cerebral sutures in children. Roentgenological description of cranio-cerebral sutures in infants showed up their significant narrowing and the increase in shadow density, early appearance of ossifications zones in the peripheral parts of the sutures, diffuse increase of cranial bones thickness because of apposition osteogenesis disorder. Results of the study show that many alterations in the cerebral cranium are accompanied with malformations of facial skeleton.

[Tactics of surgical intervention in multileveled obstructive hydrocephalus in children].

Ninety-three obstruction areas were revealed in 23 operated children aged 1.5 to 16 years who had multileveled obstructive hydrocephalus. Fifty-four endoscopic manipulations were performed. These included perforation of the bottom of the third ventricle in 9 children, resection of the cystic wall in 33, that of membranous commissures in 2, and interventriculostomy in 10. Open cystectomy was made in 1 case. Compensation of hydrocephalus was achieved in 16 (64%) children; there was no need for revision of the preinserted and nonfunctioning shunt in 5 cases. Internal drainage operations were ineffective in 7 cases (remaining liquor hyporesorption in 3 cases and uncoupling of ventricles and subarachnoidal spaces in 4), in this connection, VP shunts were implanted or the preinserted ones were preserved. In 3 (13%) children, complications (moderate ventricular hemorrhages (n=2) and an exacerbation of aseptic ventriculitis (n=1)) were successfully abolished. Four children underwent resurgery due to closure of the preapplied cystic stoma. There were no fatal outcomes. Thus, neuroendoscopic interventions are the most effective treatment for multileveled obstructive hydrocephalus. Of priority is the creation of liquor outflow from a larger cavity that induces severe compression of cerebral structures or dislocation occlusion and from the ventricular system cavities located more orally. The need for implantation of intra- and extracranial drainages emerges only when occlusion cannot be endoscopically eliminated.

[Use of ketogenic diet in treatment of pharmacoresistant epilepsy]. / Primenenie ketogennoi diety v lechenii farmakorezistentnykh épilepsii.

Ketogenic diet (KD) is one of the most effective methods of epilepsy non-drug therapy. Ten patients with pharmacoresistant epilepsy, aged 1.5-18 years, were treated with individually matched and strictly controlled KD with high fat content and restricted amount of proteins and carbohydrates. After 1 year, only 4 patients kept the diet. Factors of efficacy, causes of withdrawal and side effects of KD are discussed.

[Gelastic seizures: etiology, semiology, therapeutic perspectives]. / Gelasticheskie pripadki: étiologiia, semiologiia, terapevticheskie perspektivy.

Gelastic seizures (laughing seizures) are a rare type of epileptic seizure in which laugh in a main and dominating manifestation of the seizure. As a rule, the seizures are caused by organic cerebral pathology and are often reported as a specific epilepsy marker related to hypothalamic hamartoma. The interictal EEG frequently shows a focal activity. Based on examination of 2 patients with gelastic seizures and hypothalamic hamartoma, clinical features, EEG characteristics and therapeutic perspectives for the disorder are discussed.

[Therapeutic drug monitoring and the pharmacokinetics of carbamazepine in children with a convulsive syndrome]. / Terapevticheskii lekarstvennyi monitoring i farmakokinetika karbamazepina u detei s sudorozhnym sindromom.

An analysis of maximal and minimal serum concentrations of carbamazepine was performed in 40 children with convulsive syndrome. All the patients received the drug for a long period. Considerable case-to-case differences of serum concentrations in spite of practically equal doses were revealed. Serum drug concentrations were therapeutically optimal (6-8 mg/ml) only in one third of children. On the basis of pharmacokinetic parameters, mean optimal dosages sufficient for maintenance of effective and safe carbamazepine concentrations were calculated. As the child grows general clearance of carbamazepine decreases. Over the age of 9 years it is significantly lower in girls than in boys of the same age. Speed of carbamazepine elimination was higher in cases of combined treatment than in cases of monotherapy. Indications and optimal time for therapeutic drug monitoring of carbamazepine are determined and clinical illustrations are presented.

[Laser reflexotherapy in the combined treatment of neurogenic bladder dysfunction in children with caudal regression syndrome]. / Lazerorefleksoterapiia v kompleksnom lechenii neirogennoi disfunktsii mochevogo puzyria u detei s sindromom kaudalnoi regressii.

The authors propose to introduce low-energy laser reflexotherapy to the complex of rehabilitative therapy for children with neurogenic dysfunction of the urinary bladder. The laser causes no pain, which enables the procedure to be used in infants, eliminates unretarded contractions of a detrusor rather effectively. A continuous reproduction of this therapeutic complex can be achieved by a relatively long-term stabilization of urination in a third of the children.

[Treatment of children with myelodysplasia, complicated by vesicoureteral reflux]. / Lechenie detei s mielodisplaziei, oslozhnennoi puzyrno-mochetochnikovym refliuksom.

Timely detection of various neurogenic urinary bladder dysfunctions in children with congenital lesions of caudal regions of the spine and their treatment in due time enable the urinary dynamics of the lower urinary tract to be stabilized early. The efficient application of conservative treatments contributes to the recovery of detrusor performance and urethral and anal sphincters in some spinal patients; however, the maximum effect was achieved in patients who had undergone intercostal autoneuroplasty. Microneurosurgical interventions on the lumbosacral roots of the spine are most likely to produce a pelvic reinnervation effect to some extent and promotes the regression of vesicoureteral reflux.

[Reconstructive microsurgery in the combined treatment of children with spinal cord disorders]. / Rekonstruktivnye mikrokhirurgicheskie vmeshatelstva v kompleksnom lechenii detei so spinnomozgovoi patologiei.

The use of microsurgical techniques in operations for autoneuroplasty with intercostal nerves in patients with congenital abnormality of the spinal cord makes it possible to adequately approximate of the interrupted roots of the spinal cord and creates promising prerequisites for restoration of pelvic and motor functions. Observations have shown that the functions of the pelvic organs in children are gradually restored and active movements appear in the lower extremities. The use of the omentum on a nutrient pedicle made it possible to arrest hydrocephalic phenomena. Due to its obvious efficacy, the suggested method can be recommended for wider use in pediatric neurosurgery.