[Subdural hematomas in infants and children of early age].

The article focuses on clinical presentation, pathophysiology and course of infantile subdural hematomas. Diagnostic procedures and surgical technique are described. Authors demonstrated results of minimally invasive surgical treatment of infantile subdural hematomas.

[The clinical and epidemiological characteristics of acute brain injury in children of the Republic of Kabardino-Balkaria].

The paper provides the data of an epidemiological survey for acute brain injury in the pediatric population in Nalchik (Republic of Kabardino-Balkaria) during 3 years (1991-1993). The incidence of acute brain injury was 4.32 +/- 0.30, 5.13 +/- 0.34, and 5.44 +/- 0.36 per 1000 children in 2001, 2002, and 2003, respectively, i.e. there is a statistically significant trend for the figures to increase (t = 2.39; p < 0.01). The death of victims was caused by their severe condition and mortality rates were 0.91; those due to brain contusion and compression were 2.68. The paper also presents the structure of victims by the severity of injury and by the differentiation of these parameters by age, and the relationship of craniocerebral traumatism to a number of social factors. Particular emphasis is laid on the quality of specialized aid. The minimum required diagnostic equipment is determined for the correct evaluation of the severity of injury. Algorithms of delivering care to children depending to their age are given, which make the work of an admission department physician easier, reduce the number of diagnostic and therapeutic errors, and promote a reduction in economic costs. The findings enable one to gain an idea of the level of craniocerebral traumatism and to define measures to improve health care.

[The role of biochemical processes in the pathogenesis of complicated hydrocephalus in children]. / O roli biokhimicheskikh protsessov v patogeneze oslozhnennoi vodianki golovnogo mozga u detei.

Spinal fluid radical formation levels, malonic dialdehyde concentrations, and intrinsic antioxidative activity were studied in 84 patients with hydrocephalus. The findings suggest that there is a considerable activation of free radical reactions and lipid peroxidation, as well as a reduction in antioxidative activity. These changes were most drastically profound in children with inflammation-complicated hydrocephalus with spinal fluid hemorrhagic changes in particular. Timely correction of impaired energy exchange in children by using antioxidants and nootropics promotes the arrest of inflammation and prevents a number of postoperative complications.

[The effect of selective dorsal rhizotomy on motor function in patients with infantile cerebral palsy]. / Vliianie selektivnoi rizotomii na dvigatel'nuiu funktsiiu bol'nykh detskim tserebral'nym paralichom.

The authors analyze the outcomes of surgical treatment in 15 CP patients with lower paraparesis who had been treated with selective dorsal rhizotomy at the L2-S2 level. All the patients were examined by neurological study, EMG, EEG, visual evoked potential (VEP) recording and motor reaction time estimation. Based on the findings, it is suggested that SPR lumbosacral spinal level may affect cerebral function. Some motor functional changes are associated with this impact. Possible mechanisms of these changes are discussed.

[Study of free radical oxidation of lipids in cerebrospinal fluid of hydrocephalic children]. / Issledovanie protsessov svobodnoradikal'nogo okisleniia lipidov v likvore detei s gidrotsevaliei.

The levels of free radical production, malondialdehyde concentration and antioxidant activity were estimated in ventricular liquor of the infants with primary hydrocephalus. It was shown that even in the case of uncomplicated hydrocephalus significant disorders in brain metabolism took place. In the patients with inflammatory or hemorrhagic complications the levels of malondialdehyde and free radicals were markedly increased as compared to the infants with "pure" hydrocephalus. The most significant disorders were revealed in the case of hemorrhagic complications. These data indicate the necessity of lipid peroxidation evaluation in liquor of the patients with hydrocephalus and help to workout indications for antioxidants including into the common therapy of this decrease.

[The use of selective dorsal rhizotomy for treating spasticity in patients with infantile cerebral palsy]. / Primenenie selektivnoi dorsal'noi rizotomii dlia lecheniia spastichnosti u bol'nykh detskim tserebral'nym paralichom.

The paper gives the results of using selective dorsal rhizotomy at the lumbosacral level in 15 children with infantile cerebral paralysis, 12 of whom were at the age of 6 to 15 years. It also discusses surgical techniques, the use of intraoperative stimulation, and the impact of selective dorsal rhizotomy on muscle tone. The paper provides evidence for the benefits of surgery reducing the muscle tone at the expense of its spastic component. Based on the relationship between the number of cut fibers as part of each root and the degree of decreased muscle tone, a procedure is proposed for conservative surgical interventions to be used in patients employing spasticity for support.

[Cerebrospinal fluid lactate and peroxide compounds in young children with craniocerebral trauma]. / Issledovanie laktata i perekisnykh soedinenii likvora u detei rannego vozrasta pri cherepno-mozgovoi travme.

The content of lactate and products of lipid peroxidation in the c. s. f. of infants with craniocerebral trauma was studied. The content of lactate and malonic dialdehyde in the c. s. f. was significantly increased, which correlated with the severity of the trauma. The results of the study make it possible to followup the course of the cerebral traumatic disease and the efficacy of the applied therapy and also may severe as prognostic criteria in evaluating the possible sequelae of the craniocerebral trauma.

[Ultrasonography of the brain in children with craniocerebral trauma]. / Ul'trasonografiia mozga u detei pri cherepno-mozgovoi travme.

The authors examined 275 children with acute craniocerebral trauma (CCT). Various types of intracranial hemorrhages and contusions of the brain were differentiated by means of ultrasonography (USG). Analysis of complex examination of children with CCT allows the conclusion that USG is a highly informative diagnostic method, particularly in infancy, which makes it possible to visualize the craniocerebral injuries and study them continuously during treatment. Intraoperative USG was conducted in older children with suspected intracranial hematoma, which allowed the pathological process to be clearly located.

[The hemostatic system in chronic intracranial hematomas in children]. / Sistema gemostaza pri khronicheskikh vnutricherepnykh gematomakh u detei.

The formation of chronic intracranial hematomas in children is discussed from the standpoint of the pathogenesis of disturbed course of the wound process. Special study of blood coagulation system in 10 unselected children with chronic intracranial hematoma showed that disorders of quantitative and qualitative characteristics of the factors of the blood coagulation system underlie this process. The role of hemorrhagic diathesis in the pathogenesis of chronic intracranial hematomas in children is emphasized.

[Involvement of the subcortical structures in children with cranio-cerebral injuries]. / Porazhenie podkorkovykh struktur mozga u detei pri cherepno-mozgovoi travme.

From experience in the management of 12 cases the authors discuss the clinical picture and pathogenesis of a special form of craniocerebral trauma in children which is characterized by isolated affection of the subcortical ganglia, internal capsule, and the thalamus in the area supplied by the perforating branches of the middle cerebral artery.

[Late results of surgical treatment of tumors of the posterior cranial fossa in children]. / Otdalennye rezul'taty khirurgicheskogo lecheniia opukholei zadnei cherepnoi iamki u detei.

The work is based on the analysis of the course followed by the disease in 533 patients aged 18 months to 15 years who underwent operation for benign and malignant tumors of the cerebellum and fourth ventricle in the period between 1964 and 1975. The late results were appraised in 1980-1981 in 269 patients. The minimum follow-up period of the surviving patients is 5 years, the maximum period 16 years. Catamnestic study showed that among all tumors of the posterior cranial fossa in children, only cerebellar astrocytoma and chorioidpapilloma were marked by a favourable late prognosis. Total sparing removal of these tumors leads to practical recovery of most patients.

[Experimental study of the microcirculatory bed of the brain. (II. Circulatory disorders after craniocerebral injuries)]. / Issledovaniia mikrotsirkuliatornogo rusla mozga v éksperimente (Soobshchenie II. Narusheniia krovotoka posle cherepno-mozgovoi travmy).

Dosed moderately severe craniocerebral injury was inflicted upon puppies and rabbits. After different periods (from 17 minutes to 3 days) perfusion with India ink was conducted under anesthesia and the no-reflow phenomenon was studied. All vessels in the experimental animals remained patent in the early (up to 2 days) period after the injury. Vasospasm with zones of obstruction of the microcirculatory bed was more or less pronounced in different areas of the brain 3 days after the injury. Microcirculation is maintained in the hypothalamus after craniocerebral injury even in the presence of gross microcirculatory disorders in the other areas of the brain, the thalamus among others.

[Use of amnion to repair a dural defect]. / Plastika defekta tverdoi mozgovoi obolochki s pomoshch'iu amniona.

Amnion stored in a LIPK-s solution is recommended for airtight closure of a defect in the dura mater in infants and young children. It may also be used in adults. Animal experiments showed that the edges of the graft placed with the inner (fetal) surface on the brain grow tightly into the dura mater along the margins of the defect with no inflammatory changes or any coarse cicatrization even in injury to the cortex. Plastic surgery of the dura mater with the amnion was carried out in the clinic in 16 children from 4 months to 7 years of age with severe and moderately severe craniocerebral trauma. No complications developed after the operation. The follow-up period is more than 5 years.

[Changes in the cerebrospinal fluid lactate concentration of children with cranio-cerebral injuries]. / Osobennosti izmenenii soderzhaniia laktata v likvore u detei s cherepno-mozgovoi travmoi.

Examination of the cerebrospinal fluid in 43 children with craniocerebral trauma revealed a dependence of the lactate content on the degree of the injury (9.2 +/- 1.2 mg% in mild trauma; 13.5 +/- 1.7 mg% in moderate trauma; 18.3 +/- 1.7 mg% in severe trauma) and the clinical course. The cerebrospinal fluid is normalized 7-10 days after a moderate brain trauma, and in 3 weeks after a severe trauma. The findings suggest that the values of the cerebrospinal fluid lactate content are lower in children than in adults (9.7 mg%, on the average, in children under 10 years of age, and 11.3 mg% in those over 10 years of age).