[The prevention of the intracranial hypertension due to general anesthesia during operations on the brain]. / Preduprezhdenie vnutricherepnoi gipertenzii, obuslovlennoi obshchei anesteziei, vo vremia operatsii na golovnom mozge.

The article deals with the analysis of changes in cerebrospinal fluid pressure (CSFP), mean arterial pressure (MAP), brain perfusion pressure (BPR), and central venous pressure (CVP) during general anesthesia in 172 patients with tumorous, tumor-like, and vascular diseases of the brain. CSFP increased sharply during preanesthesia, in administration of inhalation anesthetics, and under the effect of inadequate anesthesia during trephination of the skull. The rise in CSFP in preanesthesia can be reduced by a combination of barbiturates with neuroleptanalgesics the administration of which is continued for up to 2-3 minutes of artificial lung ventilation through a mask. To correct the rise in CSFP during the use of 70% N2O, the authors recommend preliminary 5-10-minute anesthesia with a N2O + O2 (50:50) mixture and administration of sodium thiopental (2-3 mg/kg) or seduxen (0.2-0.3 mg/kg) in the first minutes of the postintubation period.

[Cerebrospinal fluid hypotension after brain surgery]. / Likvornaia gipotenziia posle operatsii na golovnom mozge.

A severe complication, c. s. f. hypotension ( CSFH ), developed in 9 patients after intracranial manipulations for meningioma (4), intracranial aneurysm (3), and subdural hematoma (2). It occurred on the second or third postoperative day and was characterized by rapid development of general cerebral disorders (even to deep loss of consciousness) and aggravation of focal disorders. An important role in the differential diagnosis of the hypotensive and the hypertensive syndromes is attached to lumbar puncture which in cases of CSFH reveals very low c. s. f. pressure or none at all. Effective therapy for the disease includes subarachnoid infusion of up to 50-80 ml of physiological solution through a lumbar puncture and daily intravenous infusions of fluio (2 500-3 000 ml).

Total removal of acoustic neurinomas.

The authors analyze the results of total removal of acoustic neurinomas in 120 patients operated on between January, 1967, and January, 1976. The facial nerve was preserved after surgery in 65 patients (54.2%). The use of microsurgical techniques in the last 3 years of study permitted preservation of the seventh nerve in 26 of 35 operated patients (74.3%). Of 103 patients examined postoperatively, 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. In the last 3 years, 35 patients were operated on without a single death.

[Changes in cerebrospinal fluid pressure following administration of sodium hydroxybutyrate and viadril-G to patients with brain tumors]. / Izmeneniia davleniia spinnomozgovoi zhidkosti pod vliianiem oksibutirata natriia i viadrila-G u bol'nykh s opukholiami golovnogo mozga.

The effect of sodium oxybutyrate and viadril-G on intracranial pressure was tested in 30 patients with tumours in injecting an anaesthetic. The electromanometric method was applied in measuring the pressure of cerebrospinal fluid and central venous pressure. A considerable reduction of intracranial pressure was noted in inducing anaesthesia by sodium oxybutyrate (by 34.5%) and viadril-G (by 24%), which was attended by an increase in perfusional brain pressure.

[Artificial arterial hypotension during surgical treatment of intracranial aneurysms]. / Iskusstvennaia arterial'naia gipotoniia pri khirurgicheskom lechenii vnutricherepnykh anevrizm.

In studying the content of lactic and pyruvic acids in the cerebrospinal fluid of 31 patients during operation for intracranial aneurysms under halothane anesthesia, the authors established that the performance of these operations under protection of deep (40 mm Hg) and prolonged (up to 2 hrs 25 min) artificial arterial hypotension in an uncomplicated course of the surgical intervention was not attended with hypoxic damage of the brain. The danger of hypoxia developing became greater when acute disturbances of blood flow in the cerebral arteries (clipping of a vessel, spasm) occurred in the period of hypotension.

[Changes in cerebrospinal fluid pressure in neurosurgical patients during hexenal and thiopental-sodium preanesthesia]. / Izmeneniia davleniia spinnomozgovoi zhidkosti u neirokhirurgicheskikh bol'nykh pri vvodnom narkoze geksenalom i tiopentalnatriem.

Before undergoing operation on the brain, 30 neurosurgical patients were examined to determine the effect of hexenal (in 15) and thiopental sodium (in 15) central venous pressure were taken. Arterial pressure was measured by Korotkov's method. The cerebral perfusion pressure was calculated. Both anesthetics caused reduction of CSFP: hexenal by 91 +/- 12.1 mm water, thiopental sodium by 108 +/- 21 mm water. A smallrise of cerebral perfusion pressure was noted at the same time.

[Alteration of several indices of carbohydrate metabolism in the blood and cerebrospinal fluid following surgery on patients with intracranial aneurysms]. / Izmeneniia nekotorykh pokazatelei uglevodnogo obmena v krovi i spinnomozgovoi zhidkosti pri operatsiiakh u bol'nykh s vnutricherepnymi anevrizmami.

The content of the lactic acid (LA) and pyruvic acid (PA) was determined pre- and postoperatively in the arterial blood and CSF of 31 patients with intracranial aneurysms. A considerable elevation of the concentration of LA and PA was noted along with an increasing LA/PA in the CSF of patients with symptoms of ischaemic damage of the brain. During surgery under fluothane narcosis these patients also demonstrated a distinct elevation of the LA level along with an increasing LA/PA ratio. In the CSF the growing content of glycolysis metabolites was not accompanied by LA/PA changes. The employment of artificial hypotension had no important effect upon the changes of these parameters in the CSF.

[Total removal of acoustic neurinoma]. / O total'nom udalenii nevrinom slukhovogo nerva

The analysis is based on the results of a total removal of acoustic neurinomas in 120 patients operated on in 1967-1975. The facial nerve was preserved after surgery in 65 patients (54.2%). In the course of the recent 3 years the employment of microsurgical techniques permitted to preserve the VII nerve in 26 among 35 operated patients (74.3%). Among 103 examined postoperatively 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. Within the recent 3 years 35 patients were operated on without a single mortality case.