Neurosurgery and Neurology of Kazakhstan

7-10

Authors: Sadykov A.M., Korabayev R.S., Adilbekov E.B.

Objectives. Tissue microdialysis is currently a basic method for the assessment of brain metabolism. The method of tissue microdialysis is based on the passive diffusion of substances existing in the interstitial fluid of the brain through the semipermeable membrane. For the purpose of assessment of brain metabolism during intracranial pressure, cerebral perfusion pressure and brain oxygenation correction procedures, and evaluation of tissue microdialysis has been carried out as well as ICP measurement for patients with severe craniocerebral trauma at the acute stage. Methods. There has been conducted a post-hoc analysis of 13 severe craniocerebral trauma patients who underwent brain tissue microdialysis by using the clinical analyzer ISCUS (CMA Microdialysis AB, Sweden), also an ICP detector of parenchymal and ventricular localization «Codman» was installed. Results. In 13 cases there was registered an increase in the lactate/pyruvate ratio (LPR) over 25 (mmol/L). In the first group, an increase in the LPR directly correlates with the intensity of ICP increase and worsened outcome prognosis for severe craniocerebral trauma cases. In the second group, the interconnection of LPR and ICP indicators appeared to be poor. With increased LPR rates, ICP rates ranged within the upper normal limit. This fact does not reflect the final result and requires a more thorough study of the problem. Conclusion. The advantage of tissue microdialysis consists in the ability of early establishment of pathological processes before they cause systemic changes. This provides the physician with a unique opportunity to start adequate treatment several hours or even days earlier than without applying this method. Keywords: tissue microdialysis, severe traumatic brain injury (STB), lactate/pyruvate ratio (LPR).

15-17

Authors: L.R. Asenova

Objectives. Studying the effectiveness of applying acupuncture to arrest pain syndromes of varying etiology. Methods. Research material is represented by 262 pain syndrome cases. 108 of them were male patients (41.2%) and 154 were female (58.8%). During treatment procedures the methods of corporal acupuncture, Sujok therapy, moxibustion, and vacuum therapy were used. Results. The following results were obtained for the overall effectiveness of treatment: in 90.2% of cases it was possible to fully arrest or reduce pain by over 80%, and in 8% of cases intensity of the remaining pain made 30 to 50% of the initial pain level. There were no cases of ineffective treatment. Conclusion. Using various acupuncture methods has proved an effective tool for arresting pain syndromes of varying etiology if there are no contradictions to their application. Key words: pain, acupuncture, Sujok therapy, moxibustion, vacuum therapy.

23-25

Authors: Ch.S. Shashkin, B.B. Zhetpisbayev, R.M. Abdulguzhina, E.S. Zhukov

Objective. Assessment of the possibility of using stereotaxic biopsy to diagnose brain tumors in the Republican Research Center for Neurosurgery. Methods. The research involves 21 patients with massive brain lesions who have undergone stereotaxic biopsy using the Leksell system, 12 males and 9 females. Neurologic picture was dominated by right hemisyndrome and aphasia – 10 cases, epileptic syndrome – 3 cases, cephalgia – 3 cases, left hemisyndrome – 2 cases, tetraparesis – 1 case, and paralysis – 1 case. Results. In 43% cases, anaplastic astrocytoma GIII was discovered, in 19 % cases, Glioblastoma multiform was found. In 2 cases, no tumor cells were found, whereas CT scanning confirmed achieving the target point. In one case, biopsy was repeated 3 months later revealing a glioblastoma. Conclusion. Stereotaxic biopsy is an effective, minimally invasive and accurate method for brain tumor diagnosis. Key words: stereotaxic biopsy, brain tumors, tumor histology, cytology diagnostics.

31-36

Authors: A.M. Sadykov, R.S. Korabayev, E.B. Adilbekov

The article presents a literature review on the application of microdialysis in neurosurgery. Also, enzymatic brain activity is considered. It is assumed that the energy metabolism in brain cells stops functioning properly resulting in cell swelling. Microdialysis allows monitoring brain oxygenation markers and thus helps prevent secondary changes in brain tissue after a severe craniocerebral trauma. Key words: brain microdialysis, craniocerebral trauma, brain metabolism, lactate, pyruvate, glutamate

8-10

Authors: Е.К. Дюсембеков, А.R. Khalimov, R.Yu. Yunusov, I.Т. Кurmayev, U.Zh. Jumanov, R.S. Тurekulov, B.К. Zhumagulov, Е.А.Yesentayev, D.А. Kim

The article presents the results of surgical treatment methods in consequence of extensive wound from damaged nerves of hand and forearm and explains the advantages and accessibility of using the method of closing soft tissue defects by pedicle graft with axial circulation of blood. Key words: plastic hand surgery, strip technique of plastics cutaneous defects.

14-15

Authors: M.Yu. Biryuchkov

50 blocks of the lumbar part of the backbone were studied on corpses to determine vertical and horizontal sizes on the levels L3-L4, L4-L5, L5-S1. Measuring during surgery was done by using the author’s inventions. Comparative estimation of the literature and author’s data were performed. There was really variability of these formations. It was proved that there were differences in the foramen sizes taken on the corpse material and on the operation table during the surgical treatment of pain syndromes of lumbar osteochondrosis (in case of posterior, lateral and foraminal hernias). It was proved that during these pathology vertical sizes of the foramen considerably decreased and resulted in squeezing of the nervous-vascular formations. It was recommended to do controlled decompression during the operation. Key words: backbone, lumbar part, intervertebral foramen, surgical treatment.

19-22

Authors: А.К. Sadyrbekova, К.B. Nurgaliyev, D.G. Zhetkinshek

In the article the author considers the importance of symptoms of higher mental functions for diagnosis of lesions through the use of special methods of investigation and evaluation with the help of the dynamics of rehabilitative training and rehabilitation of patients with local cerebral affection. Key words: neuropsychological diagnostic, violation, rehabilitation, the highest mental function.

9-11

Authors: E.B. Adilbekov

The incidence of malignant tumors of the central nervous system in dynamics for 2004-2011 in Kazakhstan ecozones has been studied. It was found that the incidence was reduced in Aral-Syrdarya (T=−1.1%) and Irtysh (T=−3.4%) zones, in other areas indicators were growing, with the most pronounced increase in Tobol- Torgai area (T=+11.1%). Keywords: malignant tumors of central nervous system, the incidence, dynamics and ecological zones.

18-21

Authors: E.K. Dyusembekov

The articale analyzes radicality of intracerebral malignant gliomas removal of 225 patients. There is a correlation between tumour's gystological picture and removal degree. Malignant and the most malignant cases (Grade III,IV) are the most often found. Mainly subtotal removal were carried out. 77,2 % of patients had a favorable period after operation, clinical health improvement was mentioned in 82% cases. Key words: brain, malignant tumors, gliomas, radicality.

28-31

Authors: А.М.Sadykov, R.S.Кorabayev

This article reviews treatment outcomes for 65 patients with severe traumatic brain injury in 2011year. A relationship between correct and timely prehospital emergency care using ABCDE system and probability of successful treatment outcomes for patients has been demonstrated. Keywords: traumatic brain injury, severe traumatic brain injury, severe head injury, the ABCDE approach, intracranial pressure monitoring device, Glasgow coma scale, pre-hospital stage, emergency care.

7-9

Authors: B.M.Karibaev, Mukhametzhanov, O.S.Bekarissov.

The article presents results of treatment of 351 patients with thoracic and lumbar spine injuires. Postoperative complications due to surgical intervention occurred at 59 patients (16.8%), there were 30(8.5%) men and 29(8.2%) women. The most repeated complications are fractures and migration of rods and screws, brain tunic injuries, kyphotic deformation advance, failure of system due to bone resorption, thrombophlebitis of lower limb vessels, wound infection, decubitus, and sepsis. Transpedicular fixation is the most reliable stabilization in thoracic and lumbar spine and cerebrospinal injuries, use of this system can be accompanied with complications. These complications can be avoided if technique of construction fixation is strongly observed, and also orthopedic regime is observed by patients at postoperative period. Key words: thoracic and lumbar backbone fractures, spine injuries, transpaedicular fixation.

13-17

Authors: Kerimbayev Т.Т., Aleinikov V.G., Sypabekov S.Zh., Urunbayev Y.A., Kissayev Y.V., Yerezhepbekov B.S.

Objectives. To evaluate the effectiveness of tubular access technique of interbody PLIF- Cage fusion and percutaneous pedicle fixation. Methods. Radiological and clinical outcomes were evaluated, including the MRI, CT , X-ray with functional loads, electroneuromyography, Visual analog score (VAS) for lower back pain (VAS-BP) and leg pain (VASLP), and Oswestry Disability Index, before admission , at discharge and at 3, 6, 12 months after surgery. The average follow-up was 6 - 12 months. The tubular Access through (Quadrant ®, Medtronic) retractor with microscopic discectomy and PLIF - Cage (PEEK cage Capstone ®, Medtronic) and percutaneous pedicle screw fixation with the Sextant 2 , Medtronic and Viper 2 , De Puy system, was performed. Results. Clinical VAS-BP, VAS-LP and JOA scores were significantly improved at (P<0,05) between the preoperative period (average, 6/10) and on the day of discharge (on average, 2/10 ) , in ODI scale also noted improvement (P <0,07) compared to the pre-operation (average 43,5 %) after discharge (12,8 %). At the follow up period of 6 - 12 months the relief of clinical symptoms was observed in 38 patients, residual back pain in 6 patients, moderate radicular pain in 3 cases. Good consolidation according to CT observed in the majority of cases, insufficient in 2 – osteoporotic patients . The mean postoperative hospital stay was 7,5 days. Conclusion. The minimally invasive posterior lumbar interbody fusion through a unilateral approach and subsequent tubular percutaneous fixation is an effective method of surgery for vertebral-motion segment instability. Key words: spinal instability, spodylolistes, percutaneous transpedicular fixation, PLIF- cage.

23-26

Authors: Sh.T. Taylakov, L.V. Schischkina.

Most hemangiopericytomas are located in the musculo-skeletal system and the skin, while the intracranial location is rare. In a review paper, an analysis of publications in the world literature on the problem of diagnostic method and treatment of hemangiopericytomas. Radical surgery is the treatment of choice, but must be completed with postoperative radiotherapy, which has proved to be the therapy most strongly related to the final prognosis. Hemangiopericytomas have a relentless tendency for local recurrence and metastases outside the central nervous system which can appear even many years after diagnosis and adequate treatment of the primary tumour. Key words: hemangiopericytoma; meningeal; treatment; prognosis.

33-37

Authors: Mikhailova N.V., Savinov S.V., Akchurina I.E., Grebenyukova I.V., Utebekov Z.E., Sitnikov I.Y., Abedimova R.A., Esimova G.N., Sinitsina T.N.

Gemimegalentsefaly - serious malformation of the brain, which always combined with severe symptomatic forms of epilepsy. The latter, in turn, aggravate and worsen the prognosis for the child. Impossible to achieve a stable positive result against the background of selection of anticonvulsant therapy. In SVS Laboratory study of epilepsy, convulsions and family monitoring after V.M.Savinova observed a child with congenital malformation of the brain - gemimegalentsefaly. Parencephaly put at prenatal diagnosis by ultrasound, and then confirmed by CT scan of prenatal. After the birth repeatedly held video EEG monitoring with the registration period of sleep and wakefulness and including attack period, neurological examination, MRI diagnosis (1,5 Tsl). Prescribed anticonvulsants combination, with low effect results. Underwent surgery –functional vertical gemisferotomy in the left side. Postoperatively, seizures were not observed. As a result, our conclusions were drawn: Treatment of choice is surgical patients while taking AEDs. Surgical treatment is based on resection of the affected hemisphere to provide the best compensatory capacities of the brain due to a healthy hemisphere. Early diagnosis and a decision on operative treatment is great prognostic value. The sooner an operation will be made, the better the work of adaptation mechanisms of the body. The main indication for postponing surgery may serve as a small child’s weight due to an increased risk of breaking bcc intraoperative conditions. Key words: gemimegalentsefaly, prenatal diagnosis of congenital malformations of the brain, gemisferotomy, hemispherectomy.