[Critical hydrocephalus in children (causative factors, results of treatment)].

Aim of this study was to discover the causes of critical hydrocephalus in children, determine prognostic factors of possibility of reparative processes in the brain and to analyze the results of shunting procedures in critical hydrocephalus. The series included 96 pediatric patients aged from 3 months to 2 years. All patients underwent ventriculoperitoneostomy. Optical and electron microscopy of brain tissue samples was performed in 10 cases. Follow-up period varied between 2 and 17 years. We observed negative effect of inflammatory and ischemic-hemorrhagic etiology of hydrocephalus on outcome as well as number of surgeries. Positive factors included: congenital hydrocephalus and early surgical treatment. Sizes of ventricles normalized in 25% of cases, decreased in 38.5% and remained unchanged in 36.5% of cases. Dynamics of ventriculomegaly correlated with quality of life. Almost in half of cases good (19%) of average (30%) level of quality of life was achieved. Microscopic examination of cortex and white matter discovered correlation of destructive changes with severity of hydrocephalus not only due to CSF hypertension. These alterations were present predominantly in glial cells. Preservation of most neurons and proliferation of glia provide high chance of nervous tissue reparation and restoration of cerebral functions after cessation of CSF hypertension.

[Postoperative mutism in children with the posterior fossa tumors]. / Posleoperatsionnyi mutizm pri opukholiakh zadnei cherepnoi iamki u detei.

Over 10 years (1990-1999), the Pediatric Department, Ukrainian Institute of Neurosurgery named after Academician A. P. Romodanov, operated on 376 children with posterior fossa tumors. Thirty two 8.7% children developed a posterior fossa syndrome and cerebellar mutism syndrome postoperatively. This paper gives a detailed analysis of the date available in the world literature on the incidence and causes of mutism, and mechanisms of its development. Many factors predisposing to mutism were identified, but no anatomic structures responsible for its formation were found. In the authors' opinion, mutism may not result from anatomic structures, but from the functioning of afferent or efferent connections to this brain region bilaterally.

[Craniocerebral trauma in children operated on earlier for hydrocephalus]. / Cherepno-mozgovaia travma u detei, ranee operirovannykh po povodu gidrotsefalii.

The specific features of the clinical manifestations, diagnosis, management of brain injury are considered in 48 patients earlier anastomosed for progressive hydrocephalus. The leading features are mild focal neurological disorders, prevalent overall cerebral disturbances and no dislocational manifestations. These features are associated with the absence of hypertensive phenomena due to the presence of a drainage system and morphological substrate in children suffering from hydrocephalus, which affects the outcome of brain injury and its treatment.

[The morphological characteristics of craniocerebral and cerebrospinal hernias in children after the accident at the Chernobyl Atomic Electric Power Station]. / Morfologicheskie osobennosti cherepno-mozgovoi i spinnomozgovoi gryzhi u detei posle avarii na Chernobyl'skoi AES.

In the post-Chernobyl period of time the quantity of children operated for congenital cerebral and cerebrospinal hernia has been increased almost by two times. The signs of degeneration were not observed while morphological study of hernial sac wall in 96 children operated on from 1981 till 1986 year. Of 167 children operated on after the Chernobyl accident (1986-1992 yrs) in 10 (5.9%) of them the degeneration of substantia medullaris astrocytes was observed.

[Emergency in children with implanted cerebrospinal fluid shunt]. / Neotlozhnoe sostoianie u detei s implantirovannoi likvoroshuntiruiushchei sistemoi.

In 455 pediatric patients with progressive hydrocephaly of non-tumour genesis, a valve liquoro-shunting system was implanted. At different periods after the operation (up to 5 years), 4.8% of the patients developed the purulent-infective complications, dysfunction of a system occurred--in 20.4%. The causes, clinical signs of the emergency state are analysed, the recommendations on carrying out the therapeutic measures are given.

[Supratentorial extra-axial arachnoid brain cysts]. / Supratentorial'nye ékstraaksial'nye arakhnoidal'nye kisty golovnogo mozga.

Supratentorial extra-axial arachnoidal cysts are congenital benign formations of intracranial location filled with cerebrospinal fluid. The clinical symptomatology of arachnoidal cysts depended on the age of the patient and presence of complications. The pathogenetically justified surgical method of treatment of arachnoidal cysts in children is excision of cyst wall, emptying of its cavity, creation of shunt with the subarachnoidal spaces and basal cisternae in association with cystoperitoneostomy. In the adult patients additional cystoperitoneotomy is not performed.

[Otogenic and rhinogenic brain abscesses in children]. / Otogennye i rinogennye abstsessy mozga u detei.

Otogenic and rhinogenic abscesses of the brain in children (25 cases) constitute 4.4% of neurosurgical pathologies and 26.9% of all brain abscesses in children. Rhinogenic abscesses (10 cases) were located in the frontal lobes and otogenic abscesses (15 cases) were found supra- or subtentorially. It is difficult to diagnose brain abscesses in children. In this respect computer tomography is very valuable. All the above patients underwent surgical intervention, which included such methods as aspiration, drainage and block removal. The lethality rate was 36%, although during the last 5 years (9 cases) no lethal cases were recorded.

[The bases of epidemiological surveillance for postinjection complications]. / Osnovy épidemiologicheskogo nadzora za postin''ektsionnymi oslozhneniiami.

To carry out the epidemiological analysis of postinjection suppurations and to introduce the relevant prophylactic measures, the forms of registration and account for suppurative inflammatory diseases should be legitimized and the data on such cases per the number of injections made at therapeutic and prophylactic institutions and their branches should be calculated. The organization of centralized sterilization of instruments and the 100% provision of all institutions with these instruments can reduce the occurrence of postinjection suppurations.

[Surgical treatment of contusion foci in different age groups]. / Khirurgicheskoe lechenie kontuzionnykh ochagov u postradavshikh razlichnykh vozrastnykh grupp.

The specific features of surgical treatment of contusion foci in patients of various age groups were studied basing on analysis of 606 cases. Two groups of cases were analysed: those with an isolated brain contusion and cases with contusion and compression of the brain by hematoma and bone fragments. It is shown that removal of the contusion foci in patients of various age groups improves the results of treatment. The patient's age has an essential influence on the choice of surgical tactics in brain contusion.

[Surgical treatment of decompensated craniostenosis]. / Khirurgicheskoe lechenie dekompensirovannogo kraniostenoza.

The work is based on the analysis of 148 patients with decompensated craniostenosis who underwent operation at the neurosurgical clinic of Oran (the Algerian People's Democratic Republic). The specific features of the clinical manifestations of decompensated craniostenosis are discussed. Sixty-five patients were operated on by the method suggested by V. A. Kozyrev and A. A. Arendt, and 81 patients by a modification of the method (one-stage bilateral craniectomy). Catamnestic examination showed the suggested method to be highly effective in decompensated craniostenosis. No fatal outcomes were recorded.

[Arterial aneurysms imitating tumors of the sellar area]. / Arterial'nye anevrizmy, imitiruiushchie opukholi selliarnoi oblasti.

In 3.9% of cases arterial aneurysms took the clinical picture of tumors of the sellar region. The data of the dynamics of the disease, the neurological status, and the findings of ophthalmological, craniographic and pneumoencephalographic examination do not help in establishing the character of the pathological process exactly. To avoid complications consequent upon erroneous determination of the character of the process bilateral carotid angiography should be conducted before surgery in patients with a clinical picture of tumor of the sellar area.

[Clinical picture of craniocerebral injury with subarachnoid hemorrhages in persons of different ages]. / Klinika cherepno-mozgovoi travmy s subarakhnoidal'nymi krovoizliianiiami u lits raznogo vozrasta.

The clinical features of traumatic subarachnoid hemorrhages studied in 300 patients showed their dependence on the age of the injured. The frequency and pronounced character of impaired consciousness the incidence of combination of subarachnoid hemorrhage with fractures of the cranial bones, and the severity of brain contusion grow with the age of injured. The meningeal syndrome is most manifest in the middle-aged, mode-rate in children, and least manifest in the elderly. A complex of therapeutic measures should be carried out with due account for the character of the craniocerebral trauma and the age of the injured.

[Cryosurgery of cerebral arteriovenous aneurysms]. / Kriokhirurgiia arterio-venoznykh anevrizm golovnogo mozga.

The use of stereotaxic cryothrombosis is sparing and sufficiently safe for the management of arteriovenous aneurysms of the brain. On the basis of experience in performing 21 operations on 15 patients, groups of patients for whom the method is recommended are distinguished (with an aneurysm no larger than 6 cm in diameter and up to 35 cm3 in volume). The method is especially promising in the treatment of small deep lying anteriovenous aneurysms. In large aneurysms the considerable blood flow makes it impossible to produce a sufficient hypothermal effect.

[Use of an electric field for experimental thrombosis of vessels and arterial aneurysms]. / Ispol'zovanie élektricheskogo polia dlia trombirovaniia sosudov i arterial'nykh anevrizm v éksperimente

Two series of experiments with canine arteries were conducted with the employment of extravascular electrodes, I volt power and I to 2500 micronA current. With a current up to 500 micron A, as well as with the optimum current (2000-2500 micronA), but with an over 3.5 mm diameter of the vessel no complete thrombosis is achieved. This, according to the author, is due to the flow rate and power of the electric field created. The critical flow rate that permits to achieve electrothrombosis of an artery, is 250-300 ml/min. Electrothrombosis of artificial aneurysms permits to achieve their obstruction rather promptly. The optimum time of thrombosing is 40-60 min with a 2000-2500 micronA current. Any further exposure to the electric field does not result in thrombosis of the vessel in question.