[Diagnostic efficiency of transcutaneous laryngeal ultrasound in assessing the mobility of vocal cord in patients with thyroid disease]. / Diagnosticheskaya effektivnost' ul'trasonografii gortani u patsientov s zabolevaniyami shchitovidnoi zhelezy.

OBJECTIVE: To assess the diagnostic efficiency of transcutaneous laryngeal ultrasound. MATERIAL AND METHODS: Ultrasound examination of the larynx and laryngoscopy was performed in 103 patients with thyroid disease. 26 (34.21%) patients who underwent surgery on the thyroid gland direct laryngoscopy and ultrasound of the vocal folds were performed twice, before and after the operation. RESULTS: Voice folds were visualized in 76 (73.8%) people. Of the 24 men, these anatomical structures were visualized in 8 (33.3%) and in 68 (86.1%) women out of 79 cases. Violations of the function of the vocal cords during laryngoscopy were detected in 5 people, sonographically in 6 people. The coincidence of the revealed pathology with ultrasound was in 4 patients, in 3 - with sonography the diagnosis was erroneous, in 1 patient it was falsely negative and in 2 cases it was falsely positive. CONCLUSIONS: In connection with the diagnostic capabilities of the method, it is advisable to use it as a screening study in the perioperative period in patients with diseases of the thyroid gland. Laryngoscopy is indicated for patients with non-visualized vocal folds, with identified pathology with ultrasound, and with clinical signs of dysfunction of the vocal cords.

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.