[Combined treatment of brain stem tumors].

During the two recent decades the introduction of new technologies to neurosurgery resulted in certain progress in diagnosis and combined treatment of brain stem tumors which still remain the most complex problems of neurooncology. Using the present-day diagnostic complex including a thorough dynamic neurological examination, neurophysiological investigations, and visualization methods allowed not only to detect the primary forms of brain stem tumors and their sizes but also to reveal the topographoanatomical interrelationships with the stem structures that allowed to determine the chances of surgical, combined treatment or the radiation and chemotherapy treatment only. The article gives an analysis and the clinical course of the diagnosis and combined treatment of 333 children and adult patients with primary, secondary and peri-trunkal tumors of the brain stem.

[Use of modern technologies in the diagnosis and combined treatment of brain stem tumors]. / Ispol'zovanie sovremennykh tekhnologii v diagnostike i kombinirovannom lechenii opukholei stvola mozga.

The latest technologies, introduced into neurosurgery during the last 2 decades of the 20th century, ensured progress in the diagnostics and treatment of brainstem tumors--pathologies that remain until now a most complicated problem in neurooncology. The modern diagnostic tools comprising profound dynamic neurological and neurophysiological examinations (AVP, EEG) visualization techniques (CT, MRT with contrasting, MRT, spectroscopy, PET) provide for detecting not only the initial signs of stem tumors and their sizes but also their topographic interaction with the stem structures; it, in its turn, opens up a possibility to choose between the combined surgical treatment and the radiotherapy or chemotherapy alone. The clinical course, diagnosis and combined treatment of 333 children and adults with tumors bordering on the brainstem are analyzed within the case study.

[The features of the brain immune system in brain neoplasms]. / Osobennosti immunnoi sistemy golovnogo mozga pri ego onkologicheskoi patologii.

Examining responses of the local immune system of the brain in neurocancer patients suggests that the immune system is involved in the neuroimmune interaction of both physiological and pathological conditions in the central nervous system (CNS). The setting off the local immune system of the brain is of functional nature, similar to functional analogy with the local system of the mucosae. By functional analogy, the aggregate of immune responses in the nervous tissue and cerebrospinal fluid should be called local and the system that includes these responses should named the local immune system of the brain. Due to the fact that nervous, endocrine, and immune regulatory pathways intersect in the CNS (hypothalamus), it is expedient to call this aggregate of defensive factors and mechanisms in CNS more broadly--the neuroimmune system.

[The comprehensive surgical treatment of patients with degenerative lesions of the lumbosacral spine]. / Kompleksnoe khirurgicheskoe lechenie bol'nykh s degenerativnymi porazheniiami poiasnichno-kresttsovogo otdela pozvonochnika.

On the basis of a complex analysis of surgical treatment of 52 patients with degenerative diseases of the lumbosacral part of the spine complicated by the formation of compressive reticulopathies main states were established responsible for the worse quality of life of this category of patients. Different forms of vertebrogenic radiculopathies were determined according to the morphological substrate of compression. The methods of diagnosing the spinal diseases at the lumbosacral level were estimated and the diagnostic algorithms for different variants of degenerative lesions were developed. Rational schemes of surgical correction are proposed according to the established groups of vertebrogenic lumbosacral radiculopathies. Special attention is given to prophylactics of recurrences of the pain syndrome and postoperative instability of the spine.

[Monitoring of the auditory stem evoked potentials in removal of tumors of the posterior cranial fossa]. / Monitoring akusticheskikh stvolovykh vyzvannykh potentsialov pri udalenii opukholei zadnei cherepnoi iamki.

The material of intraoperative monitoring of the acoustic stem evoked potentials (ASEP) in 9 patients with tumors of the stem and in 28 patients with the parastem localization was analyzed. It was shown that changes in the amplitude of ASEP rather than latency were the decisive factor in the assessment of the functional state of the brain stem. It was found that even the pronounced changes of the bioelectrical activity recorded during the excision of the tumor could be reversible after a change of the strategy of the operative intervention and/or after performing the necessary therapeutic measures. An important test of favorable prognosis of the postoperative course is considered to be the normalization of brain activity, ASEP included, at the final stages of the operation.

[Polycystosis of the brain]. / Polikistoz golovnogo mozga.

This paper presents a case with 11-year history of disseminated cerebral polycystosis in a 23-year-old female. Physical examination and CT, MRT, histological and biochemical data suggest that the disease is morphologically progressive; however, the spread on brain lesions showed no correlation with relatively mild clinical manifestations of the disease. Variants of nosological interpretation of histological data are discussed.

[Diagnosis and treatment of chronic cerebrovascular insufficiency in carotid atherosclerotic stenosis]. / Diagnostika i lechenie khronicheskoi tserebrovaskuliarnoi nedostatochnosti pri ateroskleroticheskom stenoze sonnoi arterii.

Examining the outcomes of surgical and medical treatments in 485 and 315 patients with brain ischemic disease, respectively, who were followed up for 13 years identified 3 stages of disease progression. Stage 1 included early signs of carotid and vertebrobasilar insufficiencies, Stage 2 involved transient ischemic attacks, minor stroke, extensive stroke, Stage 3 comprised sequelae of stroke and recurrent strokes, slowly progressive circulatory insufficiency. The early results of surgical and medical treatment for brain ischemic disease were positive in 89 and 72%, respectively. Analysis of late results (at 1 to 13 years) showed evident advantages of surgical treatment which yielded positive results in 92.1% of cases while medical treatment provided them only in 44.4% of cases. Surgical treatment was most effective in Stage 1 brain ischemic disease.

[The early diagnosis of the severity of blast trauma to the brain and auditory system]. / Ranniaia diagnostika tiazhesti vzryvnoi travmy golovnogo mozga i slukhovoi sistemy.

This paper presents the information on the early period of an explosive head trauma and trauma to the auditory system. Different types of hearing impairment, the staging of the pathological process were determined along with various immunological and biochemical changes occurring in this group of patients. The results of the study call for necessity of the early ENT observation of all patients in whom an explosive trauma is suspected.

[The diagnosis and treatment of chronic cerebrovascular insufficiency in atherosclerotic stenosis or occlusion of the carotid artery]. / Diagnostika i lechenie khronicheskoi tserebrovaskuliarnoi nedostatochnosti pri ateroskleroticheskom stenoze ili okkliuzii sonnoi arterii.

The methods of diagnosis and treatment of chronic cerebro-vascular insufficiency in atherosclerotic stenosis or occlusion of the carotid artery are described. Ambulatory examinations were performed in 62000 patients. Clinical and psychological tests were used in examining 123 patients with ischemic brain disease. The present-day diagnostic methods were used in treatment of 1100 patients (clinical tests, CT, MRT, EEG, Ag, TCD). Operations were performed on 546 patients (carotid endarterectomy, extracranial-intracranial bypass). Results of operations for making the extra-intracranial microvascular bypasses for revascularization of the ischemic hemisphere were estimated as positive. Direct correlations were found between the structural-functional state of the CNS and the degree of neurological deficiency. The 1-13 years follow-up allows a conclusion to be made that surgical treatment is more perspective than conservative methods.

[Anesthesiological support, postoperative care and the results of the surgical treatment of patients with tumors of the base of the posterior cranial fossa]. / Anesteziologicheskoe obespechenie, posleoperatsionnyi ukhod i rezul'tat khirurgicheskogo lecheniia bol'nykh s opukholiami osnovaniia zadnei cherepnoi iamki.

Problems of anesthesiological maintenance, measures of the postoperative management and results of surgical treatment of 76 patients with an oncological process on the base of the posterior cranial fossa are discussed. An analysis of informative-regulatory and adaptational reactions of organism is made on the basis of the intervalogram in the course of operative interventions near by the cerebral trunk. The results are estimated.

[A system of individual immunotherapy with leakadin in the combined therapy of acoustic neurinomas]. / Sistema individual'noi immunoterapii leakadinom v kompleksnoi terapii nevrinom slukhovogo nerva.

Analyzing the immunological responsiveness of patients with acoustic neurinomas on the antitumor immunomodulator leacadin has revealed some significant features. In leacadin-treated patients, postimmunotherapy promotes the formation of high sanogenetic responses: an increase in the rigidity of the brain-immune system; elevations of the levels of antitumor factors of the immune system: T helper cells and locally synthesized antibodies; a decrease in neuro-sensitization after tumor removal, which prevents tumor stimulation and recurrence; an indirect reduction in the activity of T suppressors that inhibit immunological responses in growing neoplasm. Immunotherapy with the antitumor immunomodulator leacadin in patients with acoustic neurinomas contributes to the development and optimization of the tumor carrier's immunological adaptative responses, creates conditions for the optimal postoperative course and prevents recurrence.

[The characteristics of the biochemical reactions of the cerebrospinal fluid in victims with gunshot wounds of the skull and brain in relation to treatment outcome]. / Osobennosti biokhimicheskikh reaktsii tserebrospinal'noi zhidkosti u postradavshikh s ognestrel'nymi raneniiami cherepa i golovnogo mozga v zavisimosti ot iskhoda lecheniia.

Biochemical reactions of the liquor were investigated in 68 patients with gunshot wounds of the skull and brain and in closed treatment of the brain wound. The reactivity of biochemical system plays a certain role in the development of infectious complications. In dead people the developing pathogenetical biochemical syndromes having a sanogenic role of clearance from antigens of the injured tissues turn pathogenesis into thanatogenesis.

[Characteristics of adaptive reactions of the body's immune system following operations for vascular anomalies]. / Osobennosti adaptatsionnykh reaktsii immunoi sistemy organizma posle operatsii po povodu sosudistykh anomalii.

Analysing the body's responses in 32 patients operated on for cerebral vascular aneurysms has shown that preoperatively there is activation of the peripheral blood antiprotease system, which appears to be associated with the impaired permeability of the vascular wall and with the activation of the hemostatic system and that their liquores contain sensitizing substances which are products of hemorrhages and cerebral detritus. On the whole, the immune responses of this group of patients are common to those of other groups of neurosurgical patients: acute-phase blood reaction, synthesizing-antibody binding of antigens, sanitating and brain tissue-transient neurosensitization. The use of mildronate contributes to the activation of the humoral link of the immune system on post-operative days 5-7, increases the serum antiprotease potential, by intensifying the body's responses, levels stress immunodeficiency and prolongs the time of neurosensitization.

[The immunological reactions and enzymatic activity of the cerebrospinal fluid in intracranial complications following neurosurgical operations]. / Immunologicheskie reaktsii i énzimaticheskaia aktivnost' tserebrospinal'noi zhidkosti pri vnutricherepnykh oslozhnenii posle neirokhirurgicheskikh operatsii.

The specific features of immunological responses and enzymatic activity of cerebrospinal fluid in the development of intracranial infectious complications were outlined in 16 neurosurgical patients after surgical interventions. On days 1-3-5 days after surgery, the immunobiochemical spectrum of cerebrospinal fluid showed substantial changes associated with the impaired permeability of the blood-brain barrier and the stress-induced transition of biochemical functional systems on the minimum functioning during anaerobic energy supply. Increasing lipid peroxidation processes reflect the result of catabolic reactions and energy deficiency, followed by intensive cytolysis of leukocytes and nerve cells. With this, antibody synthesis and great rises in the formation of circulating immune complexes is the essence of sanogenetic mechanisms basically aimed at eliminating the released and bound antigen in the given time interval.