[Characteristics of clinical presentation, diagnosis, and surgical treatment of temporal partial epilepsy].

Results of surgical treatment of 55 patients with pharmacologically resistant temporal epilepsy (age 16-43 years) admitted to Polenov Neurosurgical Institute (Saint-Petersburg, Russia) were assessed. EEG-monitoring as the part of examination protocol discovered stable focus of paroxysmal activity in frontotemporal area in 30 patients (54.5%). It is shown that the evaluated multifocal type is characterized by specific clinical, neurophysiological and neuroradiological features. Results of complex examination substantiated appropriateness of distinguishing of this type and possibility of its relevant and timely evaluation for optimization of surgical treatment. Semeiology of paroxysmal clinical symptoms, being in direct correlation with data obtained by EEG-monitoring which indicated frontotemporal localization of epileptogenic focus, shows the dynamics of pathological process in the late stages of temporal epileptogenesis. Discovered clinical and neurophysiological features determined optimal tactics of surgical management of frontotemporal type of partial epilepsy - open surgical resection of the anterior 2/3 of temporal lobe combined with subpial resection of frontal cortex with addition subpial cortical transsections with continuous intraoperative electrophysiological monitoring.

[Clinical and neurophysiologic aspects of surgical treatment of pharmacoresistant forms of epilepsy]. / Kliniko-neirofiziologicheskie aspekty khirurgicheskogo lecheniia farmakorezistentnoi épilepsii.

Surgical treatment of pharmacoresistant forms of epilepsy under neurophysiological monitoring is a key problem studied in A.L. Polenov Russian Neurosurgical Institute (Saint-Petersburg). A summary of long-term studies and main stages of surgical treatment development are presented. The indications and contra-indications, along with basic neurophysiologic strategic and tactic arguments of open and stereotaxic treatment of focal and generalized epilepsy based on neurophysiologic model which determines a role of epileptic focus, epileptic and inhibiting brain systems in spreading and arresting of seizure discharge at each disease stage are formulated. A program of clinico-neurophysiologic monitoring of temporal epilepsy in pre- and intraoperative periods is considered.

[Prognosis of early outcomes of severe craniocerebral injuries depending on duration of neurological syndromes and complications]. / Prognozirovanie rannikh iskhodov tiazheloi cherepno-mozgovoi travmy v zavisimosti ot dlitel'nosti nevrologicheskikh sindromov i nalichiia oslozhnenii.

A mathematical model is presented of prognosis of early (within the periods of stationary treatment) outcomes of a severe cranio-cerebral injury according to the main indicator--"favorable outcome--discharged from the hospital", "unfavorable outcome--died" depending on 10 indicators characterizing the patient's age, injury, duration of neurological syndromes and intraoperative, intracranial postoperative and somatic complications. The model was developed with the help of Excel and the application software Statistica and SPSS for Windows. For the development of the model of the correlative and discriminant analyses were used. The calculation of the prognosis can be made with the help of a computer or a microcalculator.

[Changes in human cerebral cortex in various areas of concussion in severe cranio-cerebral injury]. / Izmeneniia kory bol'shogo mozga cheloveka v razlichnykh zonakh ochaga usiba s razmozzheniem pri tiazheloi cherepno-mozgovoi travme.

In 23 patients with a severe cranial-cerebral trauma the operative material (pieces of the cortex, obtained from the destructive, transitional and relatively preserved zones in the bruise foci with crushing, localized in various lobules of the cerebral hemispheres) has been studied. From 2 h up to 9 days after trauma, changes, characterizing the state of the vascular bed, nervous and glial cells have been followed. In the external area of the transitional zone in 15 patients and in the relatively preserved zone in all the patients reversibly altered nervous cells predominate. Only in the destructive zone in all 23 patients and in the whole transitional zone in 8 patients neurons in all cortical layers are deeply injured and unviable. Certain considerations on differential surgical tactics, when treating the bruise foci with crushing at a severe cranial and cerebral trauma are presented.

[Changes in respiration and hemodynamics in patients with cranio-cerebral injury after hyperbaric oxygenation]. / Izmeneniia dykhaniia i gemodinamiki u bol'nykh s cherepno-mozgovoi travmoi v usloviiakh giperbaricheskoi oksigenatsii.

Respiration, central hemodynamics, gas and acid-alkaline balance of the blood were examined in the course of hyperbaric oxygenation (HBO) sessions in 30 patients in the acute period of severe craniocerebral injury, including 15 patients with a favourable outcome and 15 patients with a subsequent lethal outcome. In the first group, HBO gave rise to a decrease in the minute respiratory volume (MRV) and, in particular, in the minute blood volume (MBV). Acid-base and gas balance of the blood remained unchanged or improved. This attests to intactness of oxygen reactivity of the brain and body on the whole and allows establishment of a favourable prognosis of the further course and outcome of disease. The second group manifested a different dynamics: the initial MRV was greater, further increasing in the course of HBO sessions, acid-alkaline and gas balance of the blood worsened towards the development of non-compensated respiratory alkalosis which reflects ineffective hyperventilation and disturbed perversed oxygen reactivity.

[Late surgical results in severe craniocerebral trauma with foci of brain crushing]. / Otdalennye rezul'taty khirurgicheskogo lecheniia tiazheloi cherepno-mozgovoi travmy s ochagami razmozheniia golovnogo mozga.

The long-term results of treatment in 130 patients with foci of crushing in the cerebral hemispheres were studied in follow-up periods of 12 months to 12 years. It was established that compensation of the disturbed functions of the central nervous system and the extent of social-occupational adaptation are dependent on the time and volume of the operative intervention, the severity of brain damage, the patients' age, the type and degree of manifestation of the hypertensive-dislocation syndrome, and the application of a complex of intensive therapy measures. A higher level of social-occupational adaptation is achieved when the focus of brain destruction is removed within the bounds of the destruction zone and before the development of the dislocation syndrome.

[Hyperbaric oxygenation in neurotraumatology]. / Giperbaricheskaia oksigenatsiia v neirotravmatologii.

The use of hyperbaric oxygenation (HBO) as a therapeutic measure has a favorable effect, in the postoperative period also, on traumatic affections of different levels of the nervous system (the brain, spinal cord, peripheral nerve trunks and plexuses. It allows the severity of the neurologic deficit and the degree of the patient's disability to be reduced and in some cases it prevents the growth of vital disorders. At the same time, the effect may exert a certain load on the adaptation mechanisms which are very limited in many neurosurgical patients. In view of this, the tolerance of the patient's organism to this load must be taken into account in choosing the HBO schedules. The tolerance is decisively determined by the intactness of the integral function of the central nervous system and diminishes markedly as the impairment of the consciousness of patients with primary affection of the brain gradually becomes deeper and longer in duration.