Yu.M. Filatov (by the 90th anniversary) Likhterman, L B; Eliava, Sh Sh
Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko,
2021, Letnik:
85, Številka:
2
Journal Article
Recenzirano
May 7, 2021 was the 90
anniversary of the birth of an outstanding Russian neurosurgeon, corresponding member of Russian Academy of Sciences, Laureate of the State Prize of USSR, Professor Yury ...Mikhailovich Filatov.
To evaluate mechanical strength of three methods of polymethyl methacrylate skull implant fixation in two experimental models.
The first experiment was performed on a plastic model that was as close ...as possible to bone in structural characteristics. The second experiment was performed on a biological specimen (a ram's head). We assessed the quality of implant fixation to bone window edges by craniofixes, ties and microscrews and lateral intercortical screws.
Craniofixes are feasible for small flat flaps, but not advisable for wide highly curved implants. They are also the most expensive method of fixation. Implant fixation by ties and microscrews is a universal method comparable in price to craniofix. Lateral intercortical fixation is effective both for small flat implants and wide implants with large curvature. However, this method is not always applicable.
Combined fixation by lateral intercortical screws and ties allows for the most effective fixation while reducing the overall price of consumables.
Typical symptoms of spontaneous intracranial hypotension syndrome are severe headache, weakness, dizziness and inability to stay upright for a long time. Most often, this syndrome occurs due to CSF ...fistula in spinal space. Pathophysiology and diagnosis of this disease are poorly known for neurologists and neurosurgeons that can complicate timely surgical care. In case of correct diagnosis, we can identify the exact location of CSF fistula in 90% of cases. Treatment eliminates symptoms of intracranial hypotension and provides functional recovery. The purpose of this article is to describe the diagnostic algorithm and successful microsurgical treatment of a patient with spinal dural CSF fistula Th3-Th4 through posterolateral transdural approach.
Decompressive craniectomy is used for arresting hypertension-dislocation syndrome developing in seriuos patients in the acute period of subarachnoid hemorrhage. After stabilization of the patient's ...neurological and somatic status, cranioplasty is performed for protective, cosmetic, and therapeutic purposes. The most common surgery in these patients is skull repair using an autologous bone graft. Before cranioplasty, the patient's bone is preserved in two ways: cryopreservation or subcutaneous implantation to the anterior abdominal wall area. Recently, there have been numerous reports of early and delayed complications of cranioplasty with autologous bone grafts. The use of artificial grafts may reduce the risk of postoperative complications compared to an autologous bone graft. Previously, 'freely' or 'manually' simulated biopolymers were used. At present, they are rarely used for repair of extensive defects due to a poor cosmetic result. However, the advent of stereolithographic modeling and computer modeling of artificial grafts has improved the cosmetic result of this surgery. The purpose of this study is to assess the risk of postoperative complications of cranioplasty as well as to define the criteria for choosing a cranioplasty technique.
Individual polymer implants are widespread for bone reconstruction after decompressive craniectomy. Despite the availability of customized titanium products, various specialists and hospitals prefer ...polymer implants.
To compare the methods of modeling and manufacturing the polymethylmethacrylate implants and identify the features affecting the quality of reconstruction.
We analyzed 14 patients with extensive skull defects after installation of polymethyl methacrylate implants. Software used for modeling of individual implants by different specialists was compared.
Satisfactory reconstruction result was obtained in all cases. There were no infectious complications. The authors outlined certain important aspects for modeling of individual polymer products: local use of anatomical thickness of the implant, leaving safe spaces, prevention of temporal retraction, template-based resection before reconstruction.
To date, skull defect closure with polymeric materials remains relevant, and even has certain advantages over customized titanium products.
Treatment of non-bleeding cerebral arteriovenous malformations (AVMs) causes a lot of controversy among neurosurgeons around the world. The most discussed issue is choosing the method and indications ...for a certain treatment option. Despite the accumulated data, including the results of randomized studies, there is no consensus on this issue among experts. The purpose of this review is to analyze current concepts of the management and reasonability of microsurgical treatment of non-bleeding cerebral AVMs based on the latest published studies.
Giant cerebral aneurysms are diagnosed more often in children than in adults. Treatment of giant aneurysms is carried out both by endovascular and microsurgical methods. Literature information on ...combination of microsurgical and endovascular operations of cerebral aneurysms at children is little. A clinical case of the combined treatment of a giant bicameral fusiform partially thrombosed aneurysm of the right vertebral artery at a 12-year-old patient and a literature review on this topic are presented. The patient underwent several complex neurosurgical interventions during two operations: 1) microsurgery including revascularization of the right posterior lower cerebellar artery, thrombectomy and trapping of the larger chamber of fusiform aneurysm of the right vertebral artery, and 2) endovascular, which consists in the installation of redirecting stent from the left vertebral artery to main artery. The uniqueness of the case which we presented lies in the fact that the tactics of stage combined treatment for a complex aneurysm at child was originally planned and successfully implemented. The treatment allowed to ensure a complete shutdown of aneurysm and to exclude postoperative cerebral complications.
Subarachnoid hemorrhages due to rupture of cerebral aneurysms have a high risk of disability and mortality. Screening of the population to detect aneurysms in patients with risk factors is currently ...not carried out in Russia. However, the detection of clinically silent aneurysms and their subsequent prophylactic surgical treatment are justified, according to numerous studies.
Demonstrate the clinical and economic feasibility of screening the population (including first-line relatives) for cerebral aneurysms using an economic and mathematical model of the RF virtual population.
Mathematical modeling was carried out using an algorithm that implements a discrete Markov chain. The virtual population consisted of 145 million people (the population of the Russian Federation). Magnetic resonance angiography 3DTOF was chosen as a screening method. Virtual patients underwent preventive surgical treatment in case of detection of aneurysm during screening. The number of aneurysms in the population, the number of aneurysmal subarachnoid hemorrhage (aSAH), the cost and outcomes of treatment, and the risk of disability were calculated.
In the case of screening and preventive surgical treatment of aneurysms, there is a decrease in the number of aSAH by 14.3% (37.5% in first-line relatives (RPLR), which affects the reduction in mortality due to aSAH by 14.4% (24.1% in The total number of disabled people is reduced by 1.5% (5.1% for the RPHR). A shift in the structure of disability towards greater labor and social adaptation of patients was noted. An economic analysis for the entire population showed that screening saves 7.7 billion annually rubles, including in the population consisting of RPLR - 4.9 billion rubles.
The created mathematical model of the virtual population demonstrated that screening and prophylactic treatment of cerebral aneurysms makes it possible to reduce the number of aSAH and associated mortality among the entire population and in the RPLR group. The number of individuals with severe disabilities is decreasing. Thus, population screening for the detection of cerebral aneurysms may be clinically effective and cost-effective in the general population, especially in RPCR.
To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation.
We analyzed 22 neurosurgical departments (19 regional and ...3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes.
The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021.
Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.
Pre-operative visualization and three-dimensional (3D) printing have gained much interest in the state-of-the-medicine. This technical note describes the technique for searching and resection of ...superficial cerebral cortical lesions. The method involves the creation of a patient-specific virtual model of cerebral cortex and 3D printing of an individual craniometric ruler (ICR) for skin incision marking. The benefits and limitations of ICR printing versus frameless neuronavigation are discussed. In addition, we outline the usage of surgical guides in the neurosurgical practice.
