Neurosurgery and Neurology of Kazakhstan

3-9

Authors: U.Ye. Аsilbekov

The present work is based on the analysis of 658 children with convulsive syndrome of the various etiology during 2006-2011 years. We analyse case records of children with the convulsive syndrome debuting at the age till three years. On the basis of the conducted research and the literature data the algorithm of diagnosis of children of the early age, suffering from convulsive attacks, taking into account accompanying infringements and a background of realization of an attack is developed. It consists of the basic diagnostic block which is spent to all children with convulsive attacks, and additional blocks which are spent selectively, depending on infringements accompanying attacks in the neurologic and somatic status. Use of the given diagnostic algorithm with the differentiated volume of diagnostic actions in practice of the doctor-neurologist and the pediatrist will allow to reduce time of hospitalisation, to reduce number of unnecessary diagnostic procedures and to reduse economic expenses for rehabilitation of children in the first years of the life, suffering from epilepsy. Key words: сonvulsive syndrome, epilepsy, children of early age, diagnostics

12-17

Authors: U. Ye. Asilbekov

Author analysed treatment of 312 children with a severe craniocerebral trauma during 2006 - 2011 years in Municipal Children hospital №2, Astana. According to age, patients have been distributed in groups: newborns (about one month), children about one year, preschool age (3-7 years) and school (from 7 till 14 years). In 256 cases there was a closed brain injury, in 32 - opened not penetrating in 24 open penetrating. The brain bruise is diagnosed in 118 cases, a serious bruise of a brain – for 84 patients, a bruise of a brain with a prelum in 98 cases and 12 cases an is diffusive-axonal trauma of a brain. At 205 children of various age groups we have established fractures of skull base and a calvarium. Children with a posttraumatic subarachnoid hemorrhage make 84,6 %. From 312 patients at 15 (4,8 %) there has come a lethal outcome. Each age group has features which need distinctive approaches in diagnostics and treatment. The most informative methods in diagnostics of a severe brain trauma in children - are neurosonography, CT and MRI. Key words: a craniocereberal trauma, age features, children, outcomes, diagnostics

26-28

Authors: К.B. Nurgaliyev

The botulinus toxin is actively used among neurotoxins since 1989. The wide experience of its application is in this time saved up, the constant analysis of all factors promoting achievement of positive results however is required. As object of research of the author investigated 36 patients (33 men and 3 women) from which 11 patients have been affected by stroke (age 24 - 61), 11 - patients with consequences of spinal and cerebrospinal trauma (age 17-58), 9 - patients with consequences of a craniocereberal trauma (age 22-45), 3 - patients with a widespread osteochondrosis (age 32-47), 2 - the patient after removal of spinal cord lesion(age of 27-50). Injections of Dysport carried out according to the fulfilled and checked up recommendations. The estimation of efficiency of treatment was spent before an injection, and also in 1, 2 and 3 weeks after procedure by means of the modified Ashworth scale. The use of Dysport (1000-1500 units) in complex therapy has shown high efficiency. The combined therapy is most effective. Key words: botulinus toxin, Dysport, a modified Ashworth scale

32-36

Authors: R.Sh. Tankacheyev

The purpose of the present work is the estimation of possibility of carrying out of a high-grade decompression back with extended spinal stenoses in chest department of a backbone. The spinal decompression is executed by means of Key-Hall access, is one-stage on several segments of a vertebra. Patients with extended spinal stenoses of chest department of a backbone have undergone to operative treatment. Serious complications after carrying out of operative interventions didn't observe. On the basis of the received results it is possible to conclude that the described access of a decompression of a spinal cord from unilateral access is an adequate method for liquidation of a bilateral lateral and-or central stenosis of the vertebral channel and grants the right not to make stabilizing operations on chest department of a backbone. Key words: spinal stenosis, microsurgical decompression, vertebra minimally invasive surgery

41-44

Authors: Kh.А. Mustafin

One of complications after transnasal transsfenoidal endoscopic surgery of scull base tumor was nasal liquorhea and nasal epistaxis. Using these tools we can recognize all of these complications and can perform adequate treatment. We suggest neurosurgeons to use this helpful technique. Key words: nasal liquorhea, nasal epistaxis, transnasal transsfenoidal endoscopic surgery of scull base tumor

4-10

Authors: А.G. Epiphantsev, G.D. Makhambayev, B.О. Beisenov, Е.А. Kovalev, N.U. Chandarov

Spongy implants were used for the ventral spondylosyndesis in 122 injured people with compound injuries of C1, C2 vertebrae and in 20 patients with chronic atlas dislocation. Occipitospondylodesis and posterior atlantooccipital spondylosyndesis were implemented with self-locking hooks with shape memory effect. In patients with compound atlas dislocations and with Jefferson’s fractures after the posterior spinal cord decompression in 50 (41,0 %) cases occipitospondylodesis was implemented. The posterior atlantooccipital spondylosyndesis was used in 8 patients without damaging of the posterior atlant’s arch. The ventral spondylosyndesis with spongy implants was applied in the treatment of 22 18 %) patients with the front bearing complex damage of C1, C2 vertebrae as a closing phase of the front spinal cord decompression and reduction. In 42 (34, 4 %) cases the front and posterior spondylosyndesis was used. The good long-term results of the treatment were got in 78,8 % injured people. Key words: supracervical spine, spondylosyndesis, constructions with shape memory effect, spongy implants

14-17

Authors: М.М. Duisebekov

Aim was to study the concentrations of neuron specific enolase and ciliary neurotrophic factor at patients with an average and heavy degree of brain contusion during the various periods of a trauma. 24 patients with average and 18 - with a heavy trauma of a brain are examined. Markers concentrations detected by immunoenzyme assay method. Researches spent in 1, 7 and 14 day after trauma. It is established, that in the early period of contusion the level of neuron specific enolase in blood raised. An patients with average degree of contusion the enzyme maximal concentration detected for 7 day with the subsequent decrease by 14 day after a trauma. At patients with severe brain contusion the maintenance of neuron specific enolase as much as possible accrues by 7-th day and keeps high values for 14 day after a craniocereberal trauma. At patients with average degree of brain contusion the maximal level of ciliary neurotrophic factor concentration observed for 7 day. At patients with severe brain trauma the content of ciliary neurotrophic factor lower than a level of healthy people and reached the greatest values for 14 day of supervision. Simultaneous definition of concentration of neuron specific enolase and ciliary neurotrophic factor during various periods of brain injury can specify weight of damages of brain and predict an outcome of a trauma. Key words: craniocereberal trauma, brain contusion, neuron specific enolase, ciliary neurotrophic factor.

21-24

Authors: R.А.Тokshekenova

In this article we described rare case of patient with pituitary adenoma, congenital heart disease and also patient’s heart consists of three auricles. Patient was diagnosed congenital heart disease and three-auricled heart in adult age only. We would like to present our colleagues successful anesthetic manual and post-reanimation monitoring measures’ sample after pituitary adenoma endoscopic surgery. Surgery was implemented by transnasal and transsphenoidal methods. Before the surgery patient was examined in Almaty Cardio Surgical Centre after Syzganov (echocardiography researches). In the centre the diagnosis of congenital heart disease and three-auricled heart was confirmed. During the surgery the anesthetic risk was higher than surgical risk. The anesthetic measures were smooth. Patient had asystolia in early post-surgery period, reanimation measures were successful. Patient was discharged from the hospital on the 12th day after surgery. Key words: pituitary adenoma, three-auricled heart, anesthesia.

29-34

Authors: М.S. Berdihojayev

Carotid – cavernous fistula is an abnormal communication between the internal and/or external carotid artery and cavernous sinus. Contemporary treatment of the carotid – cavernous fistulas are through transarterial, transvenous and combined approach of endovascular treatment, through the internal carotid artery, external carotid artery, jugular vein and the upper orbital vein. For this purpose the detachable stents, coils, balloons, Onyx are using alone or in combination. In this article the authors examined data of 18 patients with сarotid – cavernous fistula treated with endovascular method in the period from 02.2009 to 11.2011. The purpose of study to determine the safeness and effectiveness of endovascular treatment for patients with carotid-cavernous fistula. Altogether 18 patients with сarotid – cavernous fistula (13 men and 5 women, aged 8-63 years) were treated using endovascular techniques. Complete immediately obliteration of the fistula achieved in 17 cases. Embolization with only Onyx 18 with transarterial balloon assisted access was made in one case with complete obliteration of the fistula. Complete regression of the clinical symptoms within 1 month was observed in 17 patients. Angiographic study of 15 patients within 3-6 months revealed complete obliteration of сarotid – cavernous fistula in all cases. Neurological complications after surgery occurred in 2 cases, in both cases abducens nerve paresis regressed within 2 weeks and 6 months. Combined transarterial balloon assisted embolization with coils and Onyx 18 presented effective and safe treatment for patients with сarotid – cavernous fistula.. Key words: carotid - cavernous fistula, proptosis, abducens nerve paresis, endovascular treatment, Onyx 18.

40-43

Authors: A.Z. Nurpeisov, M.A. Nurdinov, D.K. Abakov, G.K. Tolbayeva

The task of intensive therapy in patients with intracranial hemorrhages, in critical condition, is to provide the damaged brain by enough oxygen. One of the effective way of normalization of cerebral oxygenation is a correction of intracranial hypertension. The application of hyperosmolar solutions to correct ICP increases cerebral perfusion pressure and improves cerebral oxygenation, has no effect on gas exchange and does not lead to an increase of extravascular water in lungs. Key words: hyperosmolar liquid, intracraneal hemorrhage, intracranial pressure, cerebral perfusion pressure.

11-13

Authors: Е.К. Dyuisembekov, А.R. Khalimov, I.Т. Кurmayev, А.М. Iskakov, V.А. Semeklitt М.А. Aliyevв, К.К. Omarbayev

The following summarizes results of surgical treatment of patients with acute intracranial hematoma in different periods: 514 surgical patients was operated from 1991 to 1995, and 677 patients was operated during the period from 2006 to 2010. Almost twofold lowering of mortality rate observed at patients of the second group is mainly aligned with earlier delivery of speciality care, possibility of 24-hour computed tomography of surgical patients and improvement of intensive care unit support. Key words: severe head injury, acute intracranial hematoma

18-23

Authors: V.V. Кryuchkov, М.А. Аliyev, К.S. Burkutbayev, Е.М. Rahadilov

Neurosurgical treatment of cervical part of vertebrae and spinal cord injury in the critical phase shall be undertaken differentially after the detailed identification of the full range of the pathological situation. Key target of treatment of acute injury of cervical vertebrae is to restore normal anatomic interrelation, which is achieved by closed or open reposition with subsequent robust stabilisation. Upon selection of surgery approach in each particular case of vertebrae-spinal cord injury it is compulsory to reach the maximum decompression of the spinal cord and the most complete stabilisation of the damaged vertebrae segments. Key words: injury of cervical part, classification of patients according to Frankel, neurological disorders

38-41

Authors: Е.Т. Маkhambetov, А.S. Shpekovв, М.S. Berdihojayev, Ph.Kh. Smagulov

The factors affecting on microvascular decompression surgery outcome in patients with trigeminal neuralgia are analysed in presented article. The analysis included age, clinical presentation, type of trigeminal neuralgia, the duration and nature of symptoms prior to surgery, and surgical outcomes. We evaluated the data of 32 patients. Analysis of the early results of surgical treatment showed high efficiency of microvascular decompression with a low risk of serious complications. Key words: trigeminal neuralgia, microvascular decompression

44-46

Authors: R.S. Sadykova

The probability of appereance of convulsive attacs in children with CCP is more higher than in other groups. It is known that some first mounth age babies have more risks to the cramps. On the other hand we can say that the great number of children in early age have one or twice convulsive attacs without any real symptoms and serious complications or consequences after that. Because of mention that there are different tipes of convulsive attacs with hidden flowing appearance, it is important to provide early diagnostic measures, therapy “in time” and take such kind of children under clinical supervision. Key words: infantile cerebral paralysis, seizure, electroencephalogram

14-17

Authors: S.К. Аkshulakov, Т.Т. Кеrimbayev, V.G. Аleinikov, Ye.Zh. Маyev, Т.Т. Pazylbekov

In a given article the experience of a surgical treatment of spine intramedullary tumors and the technique of their removal with the use of modern microsurgical techniques are presented. There were 29 patients. In 15 cases diagnosed ependymoma, in 11 cases astrocytoma, in 3 cases other tumors. The surgical approach was a standard laminectomy, but in 8 cases gemylanminectomy. Radical resection was performed in 19 cases (65.5%), subtotal resection was performed in 7 (24,2%), biopsy in three cases (10,3%). Neurological improvement observed in 21 patients (72,4%), no changes 5 (17,2%), deterioration in 3 (10,3%). Key words: intramedullary tumors, myelotomy, ependymoma, astrocytoma

22-24

Authors: G.М. Zhulamanova

Presented work shows the influence of the level of compliance on patients with hypertensive angioencephalopathy to the treatment and rehabilitation activities for achieving target blood pressure level and to reduce risk of stroke. The study included 68 patients with hypertensive angioencephalopathy (HAE). Over a 5 year study period a significantly greater compliance of patients for implemenationt the recommendations for modifying risk factors was observed. Moreover, if the commitment to drug antihypertensive therapy over a 5 year study period significantly increased to 72,4% (p <0,05), the commitment to efforts to modify risk factors increased by only 16.3%, p> 0,05. Key words: compliance, hypertension angioencephalopathy

38-47

Authors: А.Z. Нurpeisov, M.A. Нurdinov, D.K. Аbakov, Ye.Zh. Мayev

In the given article the authors presented literature ovewiew the basic physiological and pathophysiological aspects of ICP measurement. Indications for monitoring ICP and its clinical value are presented and discussed. Monitoring of ICP allows to control and operate cerebral perfusion pressure in patients with complicated postoperative period and to apply the targeted pathogenetic therapy in the various cerebral pathology: hypostasis of a brain, cerebral dishaemia, intracranial and subarachnoid hemorrhages, hydrocephalus and etc. Keywords: intracranial pressure (ICP), history of measurement of ICP, a gradient of pressure, physiology, a pathophysiology

4-7

Authors: N. А. Ryskeldiyev

There were found albumin, glucose and cholesterol transport change on the surface of erythrocytes in acute period of brain injury depends on the severety of brain injury. The lessening of albumin amount was found in the plasma with increasing the share adsorbed on the erythrocytes albumins and cholesterol’s at sick people with severe CT (cranial trauma) and CT with fatality. It is supposed that the deterioration of increasing of adsorbed glucose is connected with its utilization in damaged brain. Key words: traumatic brain injury, adsorbed – carrier function of erythrocytes

11-14

Authors: А.S. Аbdualiyev

The article is devoted to an actual problem of neurosurgery – to the stroke consequences, especially an estimation of frequency of occurrence and features of a current of depressive frustration at patients with strokes. The work purpose was forecasting of probability of occurrence of clinical depressions in stroke period. The results of work allow to plan strategy of socially - labor rehabilitation of patients depending on weight of neurologic deficiency and depressive disturbances, premorbid features of the person. Keywords: the postapoplectic period, depressive disorder, probability forecasting

15-17

Authors: Shaun E. Gruenbaum, Benjamin F. Gruenbaum, A. Zhumadilov, Y. Mussin, M. Klein, R. Kuts, M. Dubilet, Y. Shapira , A. Zlotnik

Anesthesiologists play a vital role in the management of intracranial aneurysms (IAs). The goal of endovascular repair of IAs is the occlusion of the proximal feeding arteries or obliteration of the aneurismal sac. Destruction of the sac while sparing the parent artery can be difficult, and can lead to distal embolism and rupture. The anesthesiologist must always be prepared for potential complications. This article provides a brief description of the principles of anesthesia for endovascular repair of intracranial aneurysms, as well as the relevant epidemiological, pathophysiological, diagnostic and therapeutic points. The goal of anesthesia in endovascular IA repair is to maintain an adequate hemodynamic profile and avoid decreases in cerebral perfusion pressure. Cerebral ischemia, increased intracranial pressure (ICP), and hemodynamic instability are intraoperative concerns. Key words: anesthesia, intracranial aneurysms, endovascular repair

22-24

Authors: Kh.А. Mustafin, Ph.Kh. Smagulov, M.S. Berdihojayev, А.S. Shekov, G.К. Tolbayeva, Sh.М. Syzdykbayeva

At the differential-diagnostic estimation of new growths of neoplasm of the ear canal we always should remember the possible presence at the patient of such rare disease as a glomal tumor of the middle ear. Embolization of the afferent branches of the glomal tumor with intracranial growth in the first stage is the most functional method, allowing to suspend the further growth of the tumor. We have a chance further to remove a tumor completely, using surgical or combined treatment. Keywords: glomal tumor, embolization of vascular glomal tumor