[Puncture dilatation tracheostomy in children during transoral neurosurgical interventions]. / Punktsionnaya dilatatsionnaya trakheostomiya u detei pri transoral'nykh neirokhirurgicheskikh vmeshatel'stvakh.

Neurosurgical interventions within the ventral surface of the clivus and upper cervical vertebrae in childhood are sometimes carried out through transoral approach. In this situation, tracheostomy is safer for airway protection and mechanical ventilation compared to prolonged intubation. The world experience of percutaneous dilation tracheostomy in pediatric patients is limited due to anatomical and physiological features, such as difficult orientation in anatomical landmarks, high mobility of the trachea and small tracheal lumen. Also, the trachea easily collapses when pressed in pediatric patients that complicates safe puncture of anterior wall and can lead to perforation of posterior tracheal wall. OBJECTIVE: To describe a modified technique of video-assisted percutaneous dilation tracheostomy using additional thin guide and dilator in children of primary school age. MATERIAL AND METHODS: We considered 11 patients aged 6-12 years who underwent video-assisted percutaneous dilation tracheostomy. RESULTS: There were no perioperative complications (bleeding, false course, perforation of posterior tracheal wall). Infection of tracheostomy, fistulas or tracheal stenosis was absent. CONCLUSION: Percutaneous dilation tracheostomy may be alternative to classical surgical tracheostomy for pediatric patients. Endoscopic control and certain technical changes of percutaneous tracheostomy are necessary and provide safe manipulation. Surgery time, less trauma and minimal cosmetic defect after tracheostomy are significant advantages of this technique compared to surgical tracheostomy.

[Transoral approach in surgery for chordomas extending into craniovertebral junction: a systematic review of the literature]. / Transoral'nyi dostup v khirurgii khordom, rasprostranyayushchikhsya v oblast' kraniovertebral'nogo perekhoda: sistematicheskii obzor literatury.

To date, treatment of chordomas involves maximal tumor resection followed by proton therapy. Various approaches are used depending on location of tumor (transcranial and through natural anatomical openings (nose, mouth), as well as their combinations). Although transoral approach has been introduced into neurosurgical practice for a long time, it is routinely used in patients with chordoma only in certain hospitals in the world. OBJECTIVE: To analyze postoperative outcomes in patients with chordomas of skull base and craniovertebral joint after transoral surgery. MATERIAL AND METHODS: We analyzed literature data devoted to patients with chordomas of skull base and craniovertebral joint after transoral surgery or another approach combined with transoral access. Among 111 primary articles, we selected 38 manuscripts including description of 109 patients with skull base chordoma who underwent transoral surgery or combination of approaches including transoral one. RESULTS: Gross total resection was achieved in 45.9% (n=50) of cases including 1 patient after en bloc resection. Subtotal resection was carried out in 28.4% of cases, partial - in 24.8%, biopsy - in 0.9% of cases. The complication rate in this group was 30%. The most common events were swelling of the tongue (10%) and diastasis of posterior pharyngeal wall sutures (8.2%) that required redo surgery. CSF leakage and meningitis were rare (1.8% and 3.6%, respectively). CONCLUSION: Transoral access allows for gross total resection of midline tumors with low incidence of severe complications. Combination of transoral and transcranial approaches is advisable to increase extent of resection.

[Endoscopic transnasal resection of clival meningiomas]. / Rezul'taty endoskopicheskogo transnazal'nogo udaleniya meningiom oblasti skata.

BACKGROUND: Surgical treatment of ventral and ventrolateral meningiomas of posterior cranial fossa is difficult in modern neurosurgery. This is due to peculiarities of approach to these areas and concentration of critical structures (cranial nerves and great vessels). Currently, endoscopic transnasal approach to these meningiomas allows partial, and in some cases, total resection. However, this technique is not widespread. OBJECTIVE: To analyze the world literature data on postoperative outcomes in patients with clival and petroclival meningiomas after endoscopic transnasal resection. MATERIAL AND METHODS: We analyzed 22 articles representing treatment of 61 patients with clival and petroclival meningiomas. RESULTS: Total or near-total resection was achieved in 22.9% of cases, subtotal resection - 40.9%, partial resection - 26.2% (data were not provided in other cases). Even partial and subtotal resection leads to significant regression of symptoms. CONCLUSION: Endoscopic transnasal surgery is a full-fledged alternative to transcranial approaches in surgical treatment of clival meningiomas. It is also an additional option for patients with petroclival meningiomas after ineffective transcranial approaches. Transnasal tumor shrinkage and devascularization lead to brainstem decompression, regression of hydrocephalus and baseline clinical symptoms.

[Predictors of postoperative remission of acromegaly. (Experience of the Burdenko Neurosurgical Center)]. / Prediktory posleoperatsionnoi remissii akromegalii. (Opyt FGAU «NMITs neirokhirurgii im. akad. N.N. Burdenko¼).

BACKGROUND: Treatment of acromegaly is still an unresolved problem. Overall postoperative remission rate ranges from 34 to 85%. These values are better for microadenomas (75-90%) and worse for macroadenomas (45-70%). Identification of predictors of acromegaly remission after surgical treatment is an urgent objective to improve the quality of medical care for these patients. OBJECTIVE: To analyze postoperative freedom from acromegaly and predictors of remission. MATERIAL AND METHODS: A retrospective single-center study included 227 patients with acromegaly who underwent resection of pituitary adenoma between August 2018 and August 2021. RESULTS: Remission (normalization of serum IGF-1) was achieved in 65 (55%) patients. Growth hormone and IGF-1 index decreased after surgery in all patients. Mean preoperative serum growth hormone was 12.45 [6.88, 29.85] ng/ml, early postoperative concentration - 1.54 [0.80, 3.38] ng/ml, in delayed period - 1.15 [0.57, 3.80] ng/ml. Mean IGF-1 index was 2.18 [1.69, 2.71], 1.47 [0.99, 1.90] and 0.99 [0.74, 1.43], respectively. CONCLUSION: Significant predictors of acromegaly remission after neurosurgical treatment were age, preoperative level of growth hormone, tumor size and location, growth hormone and IGF-1 index in early postoperative period and residual tumor after surgery. Multivariate analysis revealed a significant association of acromegaly remission with small tumor size, low postoperative level of growth hormone and no residual tumor within 3-6 month after surgery.

[Endoscopic transnasal resection of clival meningiomas]. / Endoskopicheskoe transnazal'noe udalenie meningiom skata.

Treatment of clival meningiomas is still one of the unresolved issues in modern neurosurgery. There are several treatment strategies. These ones include various combinations of follow-up, surgical CSF drainage, tumor resection and radiotherapy. OBJECTIVE: To assess postoperative outcomes in patients with clival meningiomas. MATERIAL AND METHODS: We analyzed 18 patients with large or giant clival meningiomas. RESULTS: We assessed extent of resection using the scale by G. Frank and E. Pasquini (2002): total resection - 95-100%, subtotal - 80-95%, partial - 50-80%, extended biopsy - <50% of tumor. Total resection was achieved in 1 patient (5.5%), subtotal - 5 (27.8%), partial - 12 (66.7%). At the same time, brainstem decompression and regression of hydrocephalus were observed in all cases. Fourteen patients were followed-up. Median follow-up was 8.5 months. Seventeen patients underwent radiotherapy due to predominant partial and subtotal resection. Total focal dose ranged from 50 to 57 Gy in standard fractionation mode. None patient had residual tumor enlargement throughout the follow-up period. There were no lethal outcomes. CONCLUSION: Endoscopic transnasal access to clival meningiomas in appropriate anatomical features of tumor and surrounding structures is a full-fledged alternative to transcranial treatment in these patients. This approach provides total resection and brainstem decompression. These facts increase life expectancy without deterioration of the quality of life.

[Minimally invasive surgery for invaginated CII odontoid process]. / Miniinvazivnaya khirurgiya invaginirovannogo zubovidnogo otrostka CII pozvonka.

Odontoidectomy is indicated for anterior compression of the brainstem by invaginated odontoid process. This procedure can currently be performed via transoral microsurgical and transnasal endoscopic access. OBJECTIVE: To analyze the results of endoscopic transnasal odontoidectomy. MATERIAL AND METHODS: We assessed treatment outcomes in 10 patients with anterior compression of the brainstem by invaginated odontoid process. All patients underwent endoscopic transnasal odontoidectomy. RESULTS: Brainstem decompression was achieved in all cases. CONCLUSION: Currently, endoscopic transnasal approach is gradually replacing the transoral one in some patients requiring anterior odontoidectomy. Analysis of literature data reflects the development of this technique taking into account various features of surgical treatment including optimization of dimensions of surgical field, attempts to perform C1-sparing surgeries and analysis of sufficient size of trepanation. Nasopalatine and nasoclival lines are used to select optimal access. Nevertheless, the choice of access depends on equipment of the hospital and surgical experience in most cases.

[Awake percutaneous tracheostomy in neurosurgical patients: clinical cases and literature review]. / Punktsionno-dilatatsionnaya trakheostomiya u patsientov s neirokhirurgicheskoi patologiei, vypolnennaya na fone samostoyatel'nogo dykhaniya cherez estestvennye dykhatel'nye puti: klinicheskie nablyudeniya i obzor literatury.

Transoral or combined transnasal-transoral approach is sometimes used for tumor resection in patients with skull base and vertebral neoplasms. In such cases, percutaneous tracheostomy before surgical intervention is advisable. Tracheostomy facilitates surgical access, eliminates intraoperative risk of endotracheal tube kinking and provides airway protection from aspiration in early postoperative period in case of bulbar disorders, hypopharynx and tongue edema. The authors present two patients with massive proliferation of pathological tissue in nasopharynx and oropharynx that excluded tracheal intubation before tracheostomy. These patients underwent awake percutaneous tracheostomy.

[Endoscopic transnasal approach in surgical treatment of petrous temporal bone cholesteatoma extending towards the clivus. Three clinical observations and literature review]. / Endoskopicheskii transnazal'nyi dostup v khirurgicheskom lechenii kholesteatom piramidy visochnoi kosti, rasprostranyayushchikhsya v oblast' skata. Tri klinicheskikh nablyudeniya i obzor literatury.

Petrous temporal bone Cholesteatoma is widely described in the literature and accounts for up to 9% of all neoplasms of this localization. These cholesteatomas rarely spread towards the clivus. Isolated clival cholesteatomas are described only as single cases. There is currently no consensus on the choice of surgical approach for resection of similar neoplasms. OBJECTIVE: To demonstrate the possibilities of endoscopic transnasal approach in surgery for clival and petrous cholesteatoma. MATERIAL AND METHODS: This article presents 3 clinical cases: 2 patients with apical cholesteatoma of petrous part of temporal bone extending to the clivus and 1 patient with massive petrous temporal bone cholesteatoma extending towards the clivus according to the classification of Sanna M. All patients underwent endoscopic transnasal surgery. RESULTS AND CONCLUSION: In our opinion, endoscopic transnasal approach is optimal for resection of similar neoplasms. Total and subtotal resection was performed in 2 and 1 case, respectively. However, there are certain limitations of this approach in accessing the most lateral parts of the neoplasm. Nevertheless, endoscopic transnasal approach ensures resection of petrous temporal bone cholesteatoma extending to the clivus without the risk of damage to acoustic-facial cranial nerves. It is especially significant in patients without their baseline dysfunction.

[Anatomy of anterior craniovertebral junction in endoscopic transnasal approach]. / Anatomiya perednikh otdelov kraniovertebral'nogo sochleneniya pri endoskopicheskom transnazal'nom dostupe.

Modern achievements in endoscopic technologies ensure extending the indications for endoscopic transnasal approach in skull base surgery. Knowledge on topographic anatomy of craniovertebral junction is a prerequisite for surgical interventions in this area. Transnasal endoscopic surgery of craniovertebral junction is a relatively new field. Therefore, this manuscript and similar anatomical studies are extremely important for neurosurgeons.

Cell therapy assisted autotransplantation of olfactory tract into the optic nerve: A potential treatment for optic neuropathy.

Optic neuropathy is an invaliding pathology with diverse clinical manifestation and varying causes. Current understanding of etiopathological aspects of optical neuropathy does not provide an effective treatment protocol. In this article we discuss existing treatment methods, and their effectiveness, evaluated depending on disease etiology. The olfactory tract is a source of olfactory ensheating cells, whose unique properties can have treatment potential in correction of nerve degeneration. Transplantation of an olfactory tract graft into the damaged optic nerve is a technically achievable intervention, though anatomical limitations exist in the proposed surgical access. Optic nerve defects can also be potentially treated with axon growth stimulating therapy (Zymosan and CTP-cAMP). Optic neuropathy can be potentially cured by autotransplantation of a portion of the olfactory tract. Neuroanatomical and histomorphological aspects of olfactory tract autotransplantation into the damaged optic nerve are provided. Feasibility, technical and anatomical features, potential setbacks and limitations are discussed. Anatomical limitations exist, but with current neurosurgical technology can be overcome. Regenerative potential of olfactory tract glial cells plays an important role in nerve restoration and can play a crucial role in further understanding of nerve degeneration treatment.