Neurosurgery and Neurology of Kazakhstan

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