[Treatment outcome of chemotherapy with superselective cerebral artery catheterization in vegetative state patients].

The purpose of the study is to assess the impact of superselective neurotransmitter metabolic therapy in patients in a vegetative state. Superselective intraarterial infusion was conducted on 26 patients with relevant international criteria for the diagnosis of vegetative state. Comprehensive assessment of neurologic symptoms and severity of low metabolism on PET scan allowed to select the vascular pool, for the catheter installation. The catheter was placed either in the carotid or the vertebrobasilar pool. Infusion of neurotransmitter agents was conducted for 7 days continuously. Control of the level of metabolism of labeled glucose in the brain (PET) was performed within 2 weeks after arterial infusion. 14 out of 26 patients showed a positive trend of changes in energy metabolism of the brain. However, only 7 out of 14 patients showed further recovery of consciousness. The data confirms that the delivery path and a combination of medications play a definite role in the effectiveness of vegetative state therapy.

[Changes of hemo- and liquor-dynamics during intravascular interventions on venous-arterial malformations of the brain].

Changes in the arterial and venous blood flow and liquor-dynamics during intravascular venous-arterial interventions were studied in 30 patients with venous-arterial malformations of the brain. It was found that against the background of reduced venous-arterial shunting no expected drop of pressure in the jugular veins occured. Data were obtained on possible active autoregulation of pressure by the jugular veins. The investigation of pressure in the sinus system of the brain has shown that it correlates with intracerebral and systemic arterial pressure. The results obtained can be used in vascular neurosurgery, anesthesiology and neurology.

[Intracranial cavernous angiomas: ultrastructural and immunochemical study]. / Vnutricherepnye kavernoznye angiomy: ul'trastrukturnoe i immunogistokhimicheskoe issledovanie.

43 brain cavernous angiomas (CA) were clinically and morphologically studied. The presence of smooth muscles and endotheliocytes in the trabeculae was confirmed. The sources of blood supply and the nature of medullary changes at the CA periphery were clarified. The hypothesis of CA hormonal dependence has been rejected.

[Embolization of cerebrovascular aneurysms with controlled microspirals (complications and technical problems)]. / Embolizatsiia arterial'nykh anevrizm golovnogo mozga upravliaemymi mikrospiraliami (oslozhneniia i tekhnicheskie trudnosti).

The paper summarizes five-year experience with mechanically detachable microspirals for embolization of 62 arterial aneurysms in 59 patients. The complications and technical problems associated with both the specific features of this technology and anatomic types of the structure of vessels and aneurysms are described. Methods for the prevention and treatment of these complications are proposed.

[Early and late results of the intravascular treatment of cerebral aneurysms with a detachable balloon-catheter]. / Blizhaishie i otdalennye rezul'taty vnutrisosudistogo lecheniia anevrizm golovnogo mozga s pomoshch'iu otdeliaemogo ballon-katetera.

The paper analyzes the outcomes of intravascular treatment in 87 patients with cerebral aneurysms with separable a balloon catheter with a valve device. In the cold and hemorrhagic periods, mortality rates were 6.4 and 40%, respectively. The postoperative follow-ups lasted 1 to 17 years (mean 7.7 years). Recurrent subarachnoidal hemorrhage (SAH) was noted in 6.5% of cases, with not earlier than 4.5 years after intervention. The remaining patients (even with partial aneurysmal occlusion) had no recurrent SAH.

[Temporal arterial clipping and autoregulation of cerebral blood flow at surgery for intracranial aneurysms]. / Vremennoe klipirovanie arterii i autoreguliatsiia mozgovogo krovotoka pri operatsiiakh na tserebral'nykh anevrizmakh.

Preoperative dynamic autoregulatory responses in 20 patients considered as candidates for vessel temporal clipping (TC) and/or arterial hypotension (AH) at surgery for aneurysms were studied by the thigh cuff method. Normal autoregulatory responses at a regulation rate (RoR) of 20.4 +/- 2.8%/s were found in 10 patients > 30 days after subarachnoidal hemorrhage (SH) while RoR was 12.5 +/- 2.5%/s in 10 other patients (30 days, grade III WFNS showed autoregulation impairment. TC and/or AH were proceeded in 17 operated patients. One postoperative death was due to pulmonary embolism. Two poor results with persistent neurological disorders at discharge were associated with TC but in 1 patient. This patient had severe vasospasm and the lowest RoR (9%/s). There were no TC and/or AH postoperative complications in other 14 patients. All of them and 3 other patients with direct aneurysm clipping had a fair outcome.

Arteriovenous malformation of the cervical spinal cord with unusual drainage into the cranial cavity.

A case of arteriovenous malformation of the cervical cord 20 years in duration, studied angiographically, using computerized tomography scans and magnetic resonance images, as well as findings at autopsy are presented. The malformation was fed by the right vertebral artery, which entered a giant saccular aneurysm-like structure located subdurally on posterior spinal cord surface, and terminated there. Plenty of vessels of various diameter were found in the spinal cord substance at this level (C4-C6). Blood flow drained via a grossly enlarged vein at the anterior spinal cord fissure into cranial cavity, where varicose posterior fossa veins could be clearly seen and a single vertebral artery was present.

[Quantitative characteristics of cerebral blood flow and gas exchange in cerebral contusions]. / Kolichestvennye kharakteristiki tserebral'nogo krovotoka i gazoobmena pri ushibakh golovnogo mozga.

Statistical characteristics of blood flow and gas exchange parameters in patients with craniocerebral injury grouped in a different manner according to the severity of the contusion, the state of consciousness, and the general condition were obtained by electric computer processing of the results of studying hemispheric blood flow by means of 133Xe clearance in 86 cases, oxygen consumption by the brain in 36 cases, and carbon dioxide excretion by the brain by Van Slyke's method in 75 cases. A close correlation was revealed between the state of the patient's consciousness and the parameters of cerebral blood flow and gas exchange; compression in severe brain contusion was found to have a statistically significant effect on cerebral blood flow and gas exchange.

[Functional significance of the internal carotid arteries and collateral circulation in cerebral aneurysm surgery]. / Funktsional'noe znachenie vnutrennikh sonnykh arterii i kollateral'noe krovoobrashchenie v khirurgii anevrizm sosudov golovnogo mozga.

The functional significance of the internal carotid artery was appraised in 18 patients with arterial, in 8 with arteriovenous aneurysms and in one patient with atherosclerosis of the cerebral vessels. The appraisal was based on changes in the intracarotid pressure and regional cerebral blood flow (quantitative criteria) in temporary occlusion of the internal carotid artery with a double-lumen balloon catheter and on the change in the patients' clinical condition during temporary or stationary arrest of blood flow through the internal carotid artery that is studied. In large arteriovenous aneurysms, the collateral circulation ensures adequate blood supply to the brain tissue on the side of temporary occlusion of the internal carotid artery. The functional importance of the internal carotid artery in patients with arterial aneurysms points to the possibility of reconstructive operations in aneurysms of the internal carotid artery which are inaccessible for direct intervention. However, it is expedient in every case to make sure that the operation is safe by preoperative appraisal by means of the suggested method.