Neurosurgery and Neurology of Kazakhstan

3-4

Authors: Аkshulakov S.К., Кisamedenov N.G.

The purpose of the study. Improving results of treatment of neurogenic bladder dysfunction. Methods. In the period from December 2013 to July 2014 in a receiving-diagnostic department of JSC “National Center for Neurosurgery”, Astana, 23 patients who applied with clinic neurogenic bladder dysfunction of different variations were examined. Depending on the applied methods of treatment of neurogenic bladder dysfunction, patients were divided into two groups - the main and control. The main group consisted of patients who, after surgery routinely in content: Implantation of permanent sacral nerurostimulator, followed by neuromodulation. The control group consisted of patients who received only traditional conservative therapy. The criteria for evaluating treatment effectiveness is enhancement of bladder parameters registered with uroflowmetry and urination diary, by the results of the quality of life questionnaire SF-36. Results. Main group patients’ (n = 10) results of treatment showed high efficiency. There was noted that 79% of patients with hypotension and atony of bladder reached positive results of treatment in 6 months. Unaided urination recurred to the 59% of patients with impaired bladder emptying. Positive results in the control group (n = 13) treated with conservative therapy was observed in 2% of all patients. Conclusion. Sacral nerve stimulation is a highly effective treatment for patients with severe forms of infraction of the urination act. Neuromodulation of sacral nerves is an alternative, and frequently the only possible method for the treatment of patients with neurogenic bladder dysfunction. Keywords. neurogenic bladder dysfunction, implantation of permanent sacral nerurostimulator, neuromodulation.

11,12,13,14,15.

Authors: G.SH. Мambetova, K.B. Nurgaliyev, ZH.Е. Sagatbekova, А.Т. Imangozhayeva, Е.V. Кisayev

There is an overview picture of the effectiveness of methods of gradual restoration of motor skills in complex physical therapy provided as the most important step in the recovery and motor function in spinal patients. Key words: spinal injury, rehabilitation, gradual recovery of motor skills, ETP.

18,19,20,21,22.

Authors: A.M. Sadykov, E.B Adilbekov, K.K. Akhmetov, S.D.Karibay, R.S.Korabayev, Zh.S.Shakirov.

Objectives. Define a method for treating traumatic intracranial subdural hematomas of small volume. Methods. A retrospective analysis of 215 patients from March 2009 to March 2012 in the emergency department of JSC “National Research Centre for Neurosurgery” with acute small subdural hematomas, including patients with indications for a certain type of surgical treatment. Results. In 123 patients after conservative treatment brain CT showed complete resorption of hematoma цшершт 10 days. In 63 cases it was possible to convert acute hematoma into chronic form and then to apply minimally invasive tactics (closed external drainage of hematoma). For 29 patients with undesirable course of condition under medication treatment osteoplastic trepanation was performed within 3-4 days to remove the hematoma. Conclusion. A method of treating acute traumatic subdural hematomas small volume is suggested, which is based on expectant management that allows expanding the indications for minimally invasive treatment or complete resorption of hematoma on the basis of indepth understanding of severe traumatic brain injury pathogenesis. Key words: traumatic brain injury (TBI), traumatic acute subdural hematoma, small hematoma, closed external drainage of hematoma, osteoplastic skull trepanation.

27,28,29,30,31,32

Authors: A.N. Shkarubo, Sh.T. Taylakov, L.V. Schischkina, K.V. Dorosh3, A.P. Chromov

In article an example of successful treatment of patient with giant intracranial hemangiopericytoma. Hemangiopericytoma are aggressive tumors with a high rate of recurrence and distant metastasis. Although these tumors are malignant, they often reach large sizes with minimal clinical manifestations. Surgery is still the main and first step in the treatment of these tumors. Key words: Hemangiopericytoma; surgery of meningeal hemangiopericytoma

3,4,5,6

Authors: V.N. Zhdanova

Objectives. Review the causes of the oculomotor disoders and dysfunctions of the III,IV,VI cranial nerves in neurosurgical patients. Methods. The study involved the analysis of case histories of 700 patients with oculomotor disoders, treated in 2000-2013 at the Institute of Neurosurgery. Oculomotor disturbances were found in 368 women and 332 men, aged 18-78 years (mean age 38 ± 3 years), to the right - the 374, on the left - the 326. Comprehensive clinical, neurological and neuroophthalmological examination, neurovisual methods (magnetic resonance, computer tomography of the brain, craniography) were made. Results and Conclusions. Isolated dysfunction III cranial nerve observed in patients with pathology of the internal carotid artery (saccular aneurysms), brain tumors (meningeomas of medial part sphenoid bone), tumors of the orbit, in patients with brain injury (severe traumatic brain injury, fractures of the skull base, subdural hematoma). Isolated defeat VI cranial nerve seen in patients with pathology in vertebralbasilar pool, tumors of the cerebellopontine angle, in patients with severe traumatic brain injury (brain injury, fractures of the skull base). Associated lesions III,IV,VI cranial nerves varying degrees of dysfunction observed in patients with pathology of the infraklinoid part of the internal carotid artery (carotid-cavernous fistula), brain tumors (meningeomas of medial part sphenoid bone, pituitary adenoma), tumors of the orbit, combined brain injury and kranioorbital trauma (fracture orbital bones, small and large wings sphenoid bone), inflammatory diseases involving the superior orbital fissure syndrome and syndrome of the cavernous sinus. The reasons of the oculomotor disoders in patients with neurosurgical diseases, to our knowledge, are vascular processes ( 41,4%), brain tumors (37,2%), severe brain injury (20,1%), inflammation (1.3%). Key words: cranial nerves, oculomotor disorder, cerebral arterial aneurisms, brain injory, brain tumors.

10,11,12

Authors: Y.V.Yesikova

Objectives. The purpose of the study is to investigate the prevalence , features and severity of cognitive dysfunctions in patients of the «Medical and social institutions for the elderly and disabled generic Semey.» with prior stroke attack. Methods. The medical records of patients with prior stroke attack observed in the medical- rehabilitation department «MSU nursing generic Semey « was analyzed. «Mini- COG» (Borson S., 2000) test, which is a combination of tests on memorization, reproduction and drawing of clocks, was used to identify cognitive deficits. Test reveals predemention impairment and dementia. Sensitivity of the test is 99 %, specificity - 93%. Results. The medical records of 27 patients who have had a stroke investigated, 23 due to cerebral infarction and 4 cerebral hemorrhage . 15 males and 8 females in ischemic brain lesions, and 3males and 1 female in hemorrhage group. Hemorrhages to heart attacks ratio was 1:6, the male to female ratio was - 2:1. Conclusion. Cognitive dysfunctions are prevalent in ischemic brain lesions. The results showed the age dependence of cognitive impairment, indicating the depletion of the so-called «cerebral reserve» and should be considered in a treatment plan. Key words: cognitive dysfunction, stroke, old age

3-6

Authors: A.V. Borzykh, D.Y. Kovalchuk, A.A. Opryshchenko, Y.A. Goncharova.

Objectives. To study diagnostic possibilities of electroneuromyography for the definition and (or) confirmation of fingers tenosynovitis stenosans. Methods. The analysis of neuromyography research results of 56 patients with this pathology which were treated in the Regional Clinical Tuberculosis Hospital, in the hand microsurgery department in Donetsk within the period of 2008-2012. The patients were divided into two groups depending on clinical stage of the disease. The first group included 28 patients with ligamentitis at the 2nd stage, and the second one – 28 patients at the 3rd stage. The groups did not differ statistically in age (Student criteria, р<0,05), gender (criteria χ2, p<0,05) and disease severity (Wilcoxon criteria, p<0,05). To evaluate the functional state of the flexor hallucis longus muscle one fulfilled a needle or interferential surface electromyography Results. The obtained results were statistically processed using standard package of licensed application software «Office Professional 97» of company «Microsoft Corporation». The results were compared according to Student and Mann-Witney- Wilcoxon criteria. Average age norm of motor unit potentials amplitudes value in patients at the age of 45- 65 years old is 800-1000mV, with duration 9,0-9,5ms. In patients with the second clinical stage of the process the average value of motor unit potentials duration was 7,7±0,03ms, and motor unit potentials amplitude was 770,5±3,2мV, and it was 6,3±0,12ms and 541,3±6,1mV in patients with the third stage. Average polyphasy value in patients of both groups was 23,2±0,75 % and 32,3±0,94% correspondingly. By comparison of those values in different groups of patients we got statistically true difference (р<0,001). Conclusion. The motor unit potentials amplitude decrease up to the level 700-800mV is specific for the patients with the second stage of tenosynovitis stenosans, and duration is up to 7,5-8,0msec, for the patients with the third stage the values are 500-600 mV and 5,5-7,4msec correspondingly. Thus, in patients with the seconds and the third stages of tenosynovitis stenosans there is true difference in main neurometric values: motor unit potentials duration and amplitude. Electroneuromyography is an Objectives and true diagnostic method of tenosynovitis stenosans stage. Key words: electroneuromyography, tenosynovitis stenosans, treatment.

12-14

Authors: Y.V.Yesikova

Objectives: to study the stroke risk factors distribution in residents of «Medical and social establishment for elderly people and handicapped of general type in Semey city». Methods: medical records of the patients in medical and rehabilitation department of «Medical and social establishment for elderly people and handicapped of general type in Semey city». To discover stroke development risk factors one studied the results of medical groups observation, screening researches in the work. The body-weight index of residents was defined, social habits were identified. Results. The medical records of 185 residents of care home, medical group observation in medical and rehabilitation department of the establishment. The age is the Main risk factor for ischemic episodes development, neck arterial sclerosis and adiposis. 2/3 of infractions occurred in persons over 60 years old (elderly age: 60-74 years old in men, 55-74 years old in women). 45% is the persons of old age (75-90 years old in men and women), 36% fell within elderly age of 60-74 years old in men, 55-74 years old in women), 16% - persons in middle years, 3% - long-living persons (90 years and over).According to gender disaggregation the share of men and women turned out to be equal – by 50%. Conclusion. The research results showed the combination of several risk factors in most residents of care home which is undoubtedly led to a considerable increase in risk disease. That`s why identification and control of risk factors for stroke development is the best way to decrease. The individual risk of stroke development in patients. Key words: blood stroke risk factor, ishemic stroke, hemorrhagic stroke.

20-24

Authors: N.A.Ryskeldiyev, A.Zh. Zhumadildina, D.K.Teltayev, G.I.Olenbai, Kh.A.Mustafin, R.Zh. Auezova, A.Ye. Moldabekov, M.A.Tleubergenov, A.K.Kuralbayev, A.Zh. Doskaliyev.

The article described the case of brain venous infarction development after convexital meningioma excision. This complication causes big interest due to ambiguity of pathophysiological processes in postoperative brain venous infarction development. Key words: meningioma, venous infarction, venous sinuses, drainage veins, postoperative complication

29-30

Authors: Andras A. Kemeny

Surgical treatment of pathologies deep in the brain has always been hampered by the morbidity and even mortality of having to cut through normal functioning brain before getting to the abnormality. This was particularly important for multiple abnormalities, like metastatic cancer in the brain. Despite the advances over the last 50 years of microsurgery and image guided navigation within the skull, the side-effects of open surgery stubbornly remained sufficiently high for surgeons to seek an alternative. This was finally provided by the advent of radiosurgery.

3-6

Authors: M. Guk, O. Danevych

Objectives. Establishing surgical variants of pituitary microadenoma anatomy, singling out basic technical issues that arise during their removal, considering various approaches to handling pituitary microadenomas depending on their localization. Methods. The research material is represented by 66 pituitary microadenoma patients, 50 cases being females (76%), and 16 cases being males (24%). The average age of the patients was 33.5 years. The research involves adrenocorticotropin-, somatotropin-, thyrotropine-producing pituitary tumors, prolactin-producing adenomas and incidentalomas. Results. We singled out the following varieties of pituitary microadenoma surgical anatomy: anterolateral version (I), lower lateral version (II), and dorsal version (III). Conclusion. We believe that the suggested topographic-anatomical versions of pituitary microadenomas also correspond to the gradation of surgical complexity ranging from I to III. This gradation also helps predict surgical issues associated with each specific case and adequately assess the volume of the planned surgical invasion. Variant III is the most complicated one. Key words: pituitary adenoma, pituitary microadenoma, diagnosis, treatment, surgical anatomy, dura mater, microsurgical removal, endoscopic assistance, cavernous sinus, tumor invasion

11-14

Authors: A.M. Maykotova, M.K. Tundybayeva, M.R. Rabandiyarov

Objectives. Studying the cerebral status and serum concentration of neuron-specific enolase (NSE) in arterial hypertension (AH) patients. Methods. There have been examined 26 practically healthy volunteers and 42 patients suffering from arterial hypertension degree I-III of average and high risk (according to WHO classification in 1999). An assessment of the cerebral status was carried out by determining the cognitive function using the method of neuropsychological testing. Concentration rates of neuron-specific enolase were measured by applying the immunoenzyme assay method. Results. Minor cognitive disorders have been found in AH patients, especially those with the increased rate of NSE concentration in blood serum. Conclusion. Cognitive disorders and an increased level of NSE concentration in AH patients can be viewed as manifestations of cerebral dysfunction. Key words: neuron-specific enolase, arterial hypertension

18-22

Authors: N.A. Ryskeldiyev, A.Zh. Zhumadildina, D.K. Teltayev, Kh. A. Mustafin, G.I. Olenbay, A.E. Moldabekov, M.A. Tleubergenov, A.Zh. Doskaliyev

Objective. Our research is aimed to develop and evaluate an alternative method of dural plasty in the area of the posterior cranial fossa. Methods. There were conducted 17 posterior cranial fossa tumor surgeries involving dural plasty using fibrin glue and hemostatic SPONGOSTAN foam. Results. In all the cases where the method suggested by us was applied, there occurred no liquorrhea. Conclusion. Using fibrin glue combined with hemostatic foam is an alternative and economically available method of sealing dura mater during posterior cranial fossa surgeries. Key words: plasty of dural deficiency, liquorrhea, fibrin glue, foam SPONGOSTAN, posterior cranial fossa, allograft

26-30

Authors: A.M. Sadykov, R.S. Korabayev

Objective. The issue of brain collapse (continuous non-expansion of the brain after removal of intracranial hemorrhage) belongs to one of the most complicated neurosurgical problems, and possible solutions to it are becoming prominent, since brain non-expansion pathophysiology has not been studied to a sufficient extent. Methods. There has been conducted a posthoc analysis of treatment outcomes of 15 chronic subdural hematoma (CSH) patients who underwent closed external drainage (CED) of CSH. Brain collapse developed in 5 patients after CED of CSH. Results. CT-scanning of the brain of 5 patients 2 days after CED demonstrated that CSH remained at a reduced level, the brain did not expand; the drainage tube was not removed. These patients were discharged 10 days after their surgeries in satisfactory condition with regressing neurological symptoms. A month after the surgery, CT-scanning of the patients showed CSH in satisfactory condition without craniofacial, hemispheric, brainstem symptoms. Further monitoring was recommended due to the compensated condition of the patients, associated medical illness and unsolved issue of brain collapse. Conclusion. Aggressive and dangerous methods of treatment are not recommended in case of brain collapse. If the clinical neurological picture has regressed and the patient is feeling better, though CT-scanning of the brain demonstrates remaining brain compression caused by brain collapse with a limited midline shift, free ambient cistern, the authors do not recommend to repeat operations after hematoma drainage considering that there are no repeated hemorrhages. Key words: brain collapse, chronic subdural hematoma (CSH), closed external drainage (CED), the Glasgow Coma Scale, brain computer tomography scanning (CT)