Neurosurgery and Neurology of Kazakhstan

Number 4, 2013

3-6
SURGICAL ANATOMY OF PITUITARY MICROADENOMAS

Authors: M. Guk, O. Danevych

Abstract

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Number of views: 704

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

7-10
Assessments of the results of applying brain mycrodialysis in a case if severe craniocerebral trauma

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

Abstract

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Number of views: 753

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).

11-14
Cerebro vascular dysfunction in patients wit h arterial hypertension

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

Abstract

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Number of views: 720

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

15-17
EFFECTIVENESS OF ACUPUNCTURE FOR ARRESTING PAIN SYNDROMES OF VARYING ETIOLOGY

Authors: L.R. Asenova

Abstract

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Number of views: 655

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.

18-22
DURAL PLASTY IN THE POSTERIOR CRANIAL FOSSA

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

Abstract

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Number of views: 628

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

23-25
Stereota xic Biopsy of Brain Tumors

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

Abstract

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Number of views: 643

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.

26-30
BRAIN COLLAPSE IN INTRACRANIAL HEMORRHAGE

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

Abstract

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Number of views: 756

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)

31-36
BRAIN MICRODIALYSIS IN NEUROSURGICAL PRACTICE

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

Abstract

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Number of views: 761

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