[Cranial suture ultrasound for reducing radiation exposure in diagnosis of craniosynostosis in young children]. / Ul'trazvukovoe issledovanie shvov cherepa kak mera snizheniya luchevoi nagruzki v diagnostike kraniosinostozov u detei rannego vozrasta.

Currently, there are no standards for examining patients with suspected craniosynostosis. CT of the brain with 3D skull reconstruction is a common approach to diagnose craniosynostosis in many hospitals. This technique in pediatric patients is associated with a high dose of ionizing radiation and prompts searching for other diagnostic methods. OBJECTIVE: To generalize an experience of cranial suture ultrasound and compare diagnostic capabilities of various ultrasound devices. MATERIAL AND METHODS: We retrospectively analyzed data of cranial suture ultrasound in 49 patients under the age of 14 months with a suspected craniosynostosis. All patients underwent expert-class ultrasound. Of these, 10 patients underwent middle-class ultrasound. Age of these patients ranged from 2 to 10 months. RESULTS: According to ultrasound data, we have found 48 synostotic sutures in 42 patients. There were 2 inaccurate results among these 48 sutures. In both cases, expert-class ultrasound confirmed partial closure of cranial sutures while 3D CT revealed their complete closure. Sensitivity and specificity of technique were 95.8% and 100%, respectively. Both expert- and middle-class ultrasound revealed synostotic sutures in 10 children under 1 year old. CONCLUSION: Our data have shown that ultrasound of cranial sutures may be a first-line imaging technique. This method has high sensitivity and specificity in pediatric patients. Moreover, middle-class ultrasound devices may be used for diagnosis.

[Neuroendoscopic interventions using an Nd-YAG laser for multilevel hydrocephalus: treatment results for 10 patients]. / Neiroéndoskopicheskie vmeshatel'stva s ispol'zovaniem Nd-YAG-lazera pri mnogourovnevoi gidrotsefalii: rezul'taty lecheniia 10 patsientov.

INTRODUCTION: Treatment or multilevel hydrocephalus is a complex problem. Neuroendoscopic interventions, make it possible to combine minimal invasiveness with the possibility of fenestration of several cysts during one procedure and thereby eliminate multi-level occlusion. We present our the experience of using a neodymium YAG laser (Nd-YAG laser) as an additional tool to improve the treatment results of patients with non-communicating hydrocephalus. MATERIAL AND METHODS: This study included 10 patients aged from 5 months to 8 years who underwent endoscopic interventions with the use of rigid endoscope with frameless navigation. A surgical laser with a radiation wavelength of 1.064 µm was used as the main tool for fenestrating the walls of the cysts. RESULTS: 13 endoscopic laser interventions were performed in 10 patients with multilevel hydrocephalus. In 3 children, the two-stage treatment was chosen in due to the impossibility of simultaneous fenestration of all cysts. The interval between procedures was 1 month in two cases and 11 months in one case. We managed to compensate for cerebrospinal fluid disturbances in each patient, positive dynamics in the condition was noted. The duration of postoperative stay averaged 8 days (from 4 to 13 days). There were no deaths in the study group. All patients were discharged in good condition. Average follow-up duration was 14 months (from 8 to 25 months). During the observation, the condition of the patients remained stable; there was no need for repeated operations. CONCLUSION: Combined use of bypass operations, endoscopic techniques and neural navigation may improve the results of treatment of patients with multilevel hydrocephalus. Data presented in this article demonstrates the safety and effectiveness of the clinical use of laser radiation as an additional tool for interventions in patients with this condition.

[Intracranial meningiomas in children]. / Vnutricherepnye meningiomy detskogo vozrasta.

Meningiomas are rare in children and distinguished from the tumors in adults by clinical and biological aspects. Moreover, some histological forms and localizations are even casuistic in adults. There were 178 patients younger 18 years old with brain tumors. All patients underwent surgery at the pediatric department for 5-year period. Meningiomas were diagnosed in 5 cases that accounted for 2.8% of the total number of brain tumors in children. The authors reported children with intracranial meningiomas and discussed certain features of the course of disease in these patients.

[Endoscopic treatment of nonsyndromic sagittal craniosynostosis in dizygotic twins. A case report and literature review]. / Éndoskopicheskoe lechenie nesindromal'nogo sagittal'nogo kraniosinostoza u dizigotnykh bliznetsov (dvoinia). Klinicheskii sluchai i obzor literatury.

The article presents a rare clinical case of isolated sagittal craniosynostosis in dichorionic diamniotic twins. The review addresses issues of epidemiology, etiology, and pathogenesis of craniosynostosis in this group of patients.

[Factors of endoscopic third ventriculostomy efficacy in infants with obstructive hydrocephalus under one year of age]. / Faktory éffektivnosti éndoskopicheskoi ventrikulostomii dna III zheludochka u detei do odnogo goda s okkliuzionnoi gidrotsefaliei.

Endoscopic surgery for obstructive hydrocephalus in children is an alternative to shunts. Currently, the efficacy of endoscopic third ventriculostomy (ETV) in infants up to one year of age is increasingly discussed among neurosurgeons. To increase the efficacy of ETV, many surgeons raise the question: what factors may affect the efficacy of this procedure in the younger age group? OBJECTIVE: To study the factors affecting the efficacy of ETV. MATERIAL AND METHODS: A total of 88 ETVs were performed in infants under one year of age in our clinic in 2012-2016. Subsequently, 43 (48.9%) children underwent CSF shunting, and one child underwent repeated ETV. The mean time until the appearance of clinical signs of stoma closure was 3.9 months (116 days). RESULTS: The procedure was most effective in the case of congenital obstructive hydrocephalus (64.5% of successful operations) and also in children over the age of 6 months (63.6% of successful operations). The efficacy in post-hemorrhagic hydrocephalus was 40%. The efficacy in grade 4 intraventricular hemorrhage was lowest and amounted to 25%. The total efficacy of ETV in children under one year of age in our study was 51.1%. CONCLUSION: In the case of congenital obstructive hydrocephalus, the efficacy of ETV is maximal and amounts to 64.5%. To achieve the highest efficacy of ETV in infants under one year of age, careful selection of patients at the preoperative stage is necessary, with allowance for many factors affecting treatment outcome.

[Shunt-induced craniosynostosis: topicality of the problem, choice of the approach, and features of surgical treatment]. / Shunt-indutsirovannyi kraniosinostoz: aktual'nost' problemy, vybor taktiki, osobennosti khirurgicheskogo lecheniia.

RATIONALE: Shunt-induced craniosynostosis is one of the late complications of CSF shunting surgery, which affects the patient's condition, clinical picture, and treatment approach. OBJECTIVE: to evaluate the prevalence rate and clinical significance of this disease, define the indications for surgery, and choose the optimal surgical approach. MATERIAL AND METHODS: The study included 59 children with shunt system dysfunction, aged 1 to 14 years, who were treated at the Department in the period from 2014 to 2016. The inclusion criteria were as follows: 1) age at the time of examination is older than 1 year; 2) implantation of a shunt system in the first 12 months of life. The state of cranial sutures was assessed using three-dimensional reconstruction of patient's computerized tomography images. Images obtained before or in the first months after primary implantation of a shunt system were used to exclude cases of primary craniosynostosis. RESULTS: Premature synostosis of the cranial sutures was detected in 27 (46%) cases. Of these, 3 (11%) patients with clinical symptoms of increased intracranial pressure and radiographic signs of craniocerebral disproportion underwent cranial vault remodeling surgery: two biparietal craniotomies and one fronto-parieto-occipital reconstruction. In two cases, simultaneous replacement of a valve with a programmable one was performed. There were no complications after reconstructive surgery. CONCLUSION: Shunt-associated craniosynostosis is one of the late complications of CSF shunting surgery. However, its presence is not an indication for surgery and should not be a reason for surgical aggression. Surgery for increasing the intracranial volume is indicated only for secondary craniosynostosis combined with signs of craniocerebral disproportion. In these cases, reconstructive surgery is an effective treatment option for improving the patient's condition.

[Penetrating orbitocranial injury: a review of the literature and a case report of injury by a watercolor brush in a 3-year-old child]. / Pronikaiushchaia orbitokranial'naia travma: obzor literatury s opisaniem klinicheskogo sluchaia raneniia akvarel'noĭ kistochkoĭ u rebenka 3 let.

We present a rare case of orbitocranial penetrating injury by a watercolor brush in a 3-year-old child. Injuries of this localization can affect important orbital structures (eyeball, blood vessels, nerves, muscles) and cause severe intracranial damages. In some cases, diagnosis of these injuries in children may be difficult due to the lack of marked clinical manifestations. The presented clinical case illustrates the approaches for choosing methods for diagnosis of injury in childhood and subsequent treatment options.

[The use of frameless navigation during endoscopic interventions in children with multilocular hydrocephalus].

INTRODUCTION: The use of the endoscopic technique largely improves treatment outcomes in patients with multilocular hydrocephalus. However, impaired anatomy and the lack of usual landmarks often cause problems in planning and intraoperative identification of changed structures. The use of frameless navigation during endoscopic interventions can significantly facilitate surgeon tasks and increases the efficacy of surgery. During surgery, the neuronavigation system visualizes a rigid endoscope that interconnects separated ventricles and cysts. Surgery can be completed with guiding a stent through an operating channel of the endoscope and implanting a shunt system. MATERIAL AND METHODS: Ten children underwent 11 endoscopic interventions using frameless intraoperative navigation at our clinic in 2013-2014. The number of surgically interconnected compartments ranged from 3 to 5. Simultaneous placement of a shunt system was performed in 8 of 11 interventions. RESULTS: Clinical improvement as a result of the operation was achieved in all children. 2 patients underwent re-operations 5 months and 1 year after endoscopic intervention. CONCLUSION: Thus, the use of frameless navigation during endoscopic interventions makes their implementation most efficient and safe for the patient.