SURGICAL STRATEGY FOR LARGE EXTRACEREBRAL SUBTENTORIAL TUMORS.

Radical surgery over large subtentorial tumors is associated with a high risk of postoperative complications. Despite significant development of imaging technology, intraoperative monitoring, and microsurgical treatment, problems one of tottal and safe large subtentorial tumors removal remain unsolved. The most critical problem relating to large tumors of this localization is postoperative edema. Also brainstem ischemic stroke is not rare and this would partly due to the tumors overgrowthing the vertebral and basilar arteries. Retrospective analysis of 59 patients with large (more than 3 cm) tumors to the posterior cranial fossa operated over 2015-2019 yy. There was gross total tumor removal in 49 (83%) patients; subtotal tumor removal in 5 (8,5%) patients; partial tumor removal in 5 (8,5%) cases. Complications occurred in 15 (25%) patients. The use of ventral craniobasal aprroaches and their combination with posterior-lateral approaches to the large subtentorial tumors allows rapid and early, effective brain stem decompression and subsequent safe and total tumor removal. Ventral decompression of the brain stem structures (endoscopic endonasal and transoral approaches, presigmoid approach, extreme lateral approach) prevents neurological complications thus early patients activation. Postoperative mortality of 3 (5.0%) out of 59 patients can be reduced by intensifying perioperative patient's management.

[Bone and cartilaginous tumours in the sino-paranasal region with intracranial extension. Peculiarities of surgical treatment].

The objective of the present work was to study peculiarities of diagnostics of bone and cartilaginous tumours in the sino-paranasal region with intracranial extension, to substantiate the choice of the strategy and methods for the surgical intervention for the treatment of these neoplasms. The study included 19 patients with various bone and cartilaginous neoplasms in the craniofacial region. Diagnostics was based on computed tomography allowing for 3D reconstruction of the structures of interest, magnetic resonance imaging (with amplification whenever necessary), and angiography. It is proposed to use the microsurgical and pneumatic techniques to ensure the maximally complete removal of the tumours with a minimal injury to the surrounding tissues. The extension of fascial approach is recommended for the management of intracranially spreading tumours. This technique was used for the treatment of 9 patients (7 undergoing anterior craniofacial resection, 1 lateral craniofacial resection, and 1 subcranial resection) in combination with Moure and Denker rhinotomy. The transcranial approach was employed in 8 patients one of whom underwent transoral surgery and another transnasal intervention. Also, the histological structure of the tumours needs to be taken into consideration when planning the approach and the extent of the surgical intervention. It is concluded that preliminary courses of chemo and radiotherapy do not significantly improve the outcome of surgical treatment; in contrast, they promote the development of complications during the postoperative period. The results of this study indicate that for the management of benign tumours characterized by the slow growth rate (osteoma, chondroma, chordoma) the traditional ENT approaches can be supplemented by transcranial surgery. Extensive interventions (anterior craniofacial reseaction, lateral craniofacial resection) are needed for the management of aggressive malignant tumours (ostesarcoma, chondrosarcoma) without serious injury the healthy tissues; moreover, such approach increases the survival rate of the patients.

[Intraoperative plasty of complex defects of the bones and soft tissues in a craniofacial region].

The results of treatment of 159 patients, suffering craniofacial region tumors, were analyzed. In tumoral invasion of cranial bones with affection of the head soft tissues the bone defects dimensions were determined and the implants prepared preoperatively, the soft tissues defects were closed, using transposition or free microsurgical transplantation of the tissues composite complexes. The complex approach application have permitted to close the bones and soft tissues defects of the head craniofacial region with achievement of subsequent functional and aesthetic result.

[Late complications of the upper cervical vertebral column trauma]. / Pizni uskladnennia travmy verkhn'o-shyinoho viddilu khrebta.

Two different types of myelopathy course were discerned: myelopathy due to instability, occurring early after trauma, rapidly progressing and myelopathy due to the long lasting ventral compression of spinal cord at the craniocervical level, occurring in several years after trauma, slowly progressing. The conduction of occipitocervical spondilodesis using metal loop with the vertebral arches fixation in myelopathy due to instability and odontoidectomy in the spinal cord ventral compression on craniocervical level constitutes the method of choice for the late complications in craniocervical junction trauma.

[Ventral spinal cord compression on the C1-C2 levels with injury of the craniocervical junction]. / Ventral'na kompresiia spynnoho mozku na rivni C1-C2 khrebtsiv pry travmi kraniotservikal'noho z'iednannia.

While CII vertebral dent fracture, neurological complications occur due to its 4 mm shift. The direct approach application (transoral--while the dent fracture or anterolateral--while hagman fracture occurrence) makes possible to achieve an adequate decompression of spinal cord and the vertebral channel reconstruction. Rigid occipitocervical spondilodesis achievement is guaranteed by the metallic loop application and the vertebral arches fixation. While conservative treatment of such a fracture the bones fragments reposition due to the sceletal pulling conduction constitutes the preliminary stage of external immobilization (SOMI or Halo) application.