[Intraoperative computed tomography and modern navigation in surgical treatment of spine and spinal cord diseases]. / Opyt primeneniya intraoperatsionnogo spiral'nogo komp'yuternogo tomografa i sovremennoi sistemy navigatsii v khirurgicheskom lechenii zabolevanii pozvonochnika i spinnogo mozga.

Surgical treatment of spine and spinal cord diseases is one of important objectives in modern neurosurgery. Patient safety is a priority in spine and spinal cord surgery. Intraoperative imaging ensures efficacy and safe surgery with and without stabilization, preoperative marking, control of decompression and correct implant placement. Surgical C-arms and intraoperative cone-beam CT scanners are the most widespread in everyday practice. The latest achievement was intraoperative spiral computed tomography. C-arms and CT scanners with intraoperative navigation increase the efficiency and safety of surgical interventions.

[Treatment of malignant peripheral nerve sheath tumors: case reports and a literature review]. / Lechenie zlokachestvennykh opukholei obolochek perifericheskikh nervov: sluchai iz praktiki i obzor literatury.

Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue sarcomas that develop from peripheral nerve sheath cells (T. Hirose, B.W. Scheithauer). These tumors are characterized by aggressive growth with an unfavorable outcome and may develop de novo or through malignant transformation of schwannomas, neurofibromas, or ganglioneuromas. MPNSTs are characterized by a rapid course and a poor prognosis. In this article, we reported cases of patients with malignant peripheral nerve tumors of the brachial plexus trunks and spinal localization.

[Resection of a giant sacral schwannoma: case report and literature review]. / Udalenie gigantskoi nevrinomy v oblasti kresttsa: sluchai iz praktiki i obzor literatury.

Neurogenic sacral tumors are extremely rare. In most reported cases, this pathology was associated with neurofibromatosis. Sacral tumors manifest themselves at the stage when the neoplasm volume becomes giant, but these manifestations usually go unnoticed for the patient. Surgical approach to the sacral region is extremely challenging; intimate proximity of tumor capsule to vital organs, vessels, and nerves makes radical surgical treatment of these neoplasms rather difficult. A case report of radical resection of a schwannoma that was destroying the sacrum and continued to grow after radiotherapy is presented in this article.

[Results of surgical treatment for lumbar spine segmental instability]. / Rezul'taty khirurgicheskogo lecheniia nestabil'nosti pozvonochno-dvigatel'nogo segmenta poiasnichnogo otdela pozvonochnika.

AIM: To perform a comparative analysis of outcomes in patients with lumbar spine segmental instability who underwent surgical treatment using transforaminal lumbar interbody fusion (TLIF) and direct lateral interbody fusion (DLIF) techniques. MATERIAL AND METHODS: The multicenter study involved 209 patients who underwent surgery for lumbar spine segmental instability. Long-term outcomes (up to 2 years) were studied in 134 patients: patients of the first group (98 patients) underwent traditional transforaminal lumbar interbody fusion (TLIF) and transpedicular stabilization of vertebral segments; patients of the second group (36 patients) underwent direct lateral interbody fusion (DLIF) in combination with transpedicular stabilization of the lumbar vertebral segments. We used standard checkpoints for monitoring the patients' condition: before surgery, at discharge, at 3, 6 and, 9 months, and at 1 and 2 years after surgery. To follow-up the patients, we used the Visual Analogue Scale, Oswestry Disability Index, and Goal Attainment Scaling. RESULTS: A comparative analysis of the two interbody fusion techniques was enabled by the developed Vertebrologic Registry profile (http://spineregistry.ru/Register_treatment.php) that was designed for entering data of Russian and foreign experts to analyze clinical characteristics, evaluate outcomes, and follow-up patients with degenerative lumbosacral spine diseases. In both groups of patients, a significant decrease in the pain intensity in the lumbar spine and lower extremities (VAS) occurred in the immediate postoperative period, which persisted in the long-term period. There were no differences in the disability level (Oswestry index) in both groups of patients (p<0.05). An analysis of treatment goal attainments one year after surgery revealed the best result in patients of the second group who underwent DLIF. CONCLUSIONS: 1. Indirect decompression using direct lateral interbody fusion (DLIF) minimizes the risks of intraoperative injury to the dura mater and neural structures. Kawabata class I outcomes (good) were achieved in 89% of patients who underwent direct lateral spinal fusion (DLIF) and in 81% of patients who underwent transforaminal interbody stabilization in combination with transpedicular fixation.

[PREDICTING, POSSIBLE WAYS TO REDUCE AND CORRECTION OF MASSIVE INTRAOPERATIVE BLOOD LOSS IN SPINAL TUMOR SURGERY].

The paper discusses the problem ofpredicting, prevention and therapy of massive intraoperative blood loss in patients with metastasis in spine and spinal cord. We analyze 60 surgical cases in last 14 years in our clinic. Amount of blood loss was more that 80% of total blood volume in each case (from 2.5 to 17 liters). Preoperative selective angiography data on intensity of tumor blood supply were essential for blood loss prediction. Simultaneous embolization oftumor during angiography dramatically reduced intraoperative blood loss. Combination of blood saving techniques (preoperative autodonation, acute normovolemic hemodilution and intraoperative cell salvage) led to effective compensation of blood volume deficit and minimizing of allogenic blood transfusion. Plasma-derived and recombinant factors were effective in management of hemostatic disorders associated with massive blood loss.

[Comprehensive assessment of the outcomes of surgical treatment of patients with metastatic spinal cord injuries].

INTRODUCTION: Every year the number of cancer patients increases due to increased life expectancy. According to various sources, metastases in the spine are found during autopsy in 30-90% of patients with a history of cancer. So far, there have been no full-scale studies of the quality of life of patients with various metastatic tumors of the spine who underwent surgical treatment in Russian literature. The main objective of this study was to demonstrate the need for implementing the comprehensive treatment of patients with metastases in the spine and target setting as the main tool to identify the factors that adversely affect the patients' quality of life. MATERIAL AND METHODS: The quality of life of 56 patients aged 16 to 81 years was assessed, including 26 males and 30 females. Twenty-six patients underwent surgical treatment between 2002 and 2009, and thirty patients underwent surgical treatment between 2009 and 2014. Kidney cancer was a primary disease in 30.3% of patients, multiple myeloma was a primary disease in 23.1% of cases, and the primary source of a tumor was not identified in cancer screening in 10.5% of cases. There were also isolated cases of melanoma, thymoma, metastases of tumors of the gastrointestinal tract, uterus, ovary, lung, prostate, pancreas, and the thyroid gland, which on the average amounted to 3.5% (1.8 to 7.14%). The quality of life of patients was studied using the EORTC QLQ C30 scale. The patients were surveyed prior to the surgery and then 1, 3, 6 and 12 months after surgical treatment during 1 year or until death. Preoperative and postoperative contrast-enhanced SCT and MRI examinations were used to control the extent of decompression of neural structures. RESULTS: On the basis of these findings, the authors identified the main factors affecting the quality of life of patients and formulated a range of treatment goals for patients with metastases in the spine. CONCLUSION: Surgical treatment has a positive effect on the quality of life of patients with metastases in the spine. However, it is not a key factor in the context of survival rate of these patients. Therefore, a decision on the possibility and necessity of surgical treatment should be taken in cooperation with the patient and oncologists of different specialties.

[Spinal neurosurgical intervention in a patient with end-stage renal disease (ESRD)].

The article presents the description of clinical observation, in which spinal neurosurgical intervention was successfully made in a patient with ESRD, receiving chronic hemodialysis for 20 years. In this context, we discuss the various clinical and tactical aspects of the management of patients with this severe co-pathology: infusion-transfussion therapy, peculiarities of anesthetic management and intra-operation monitoring, diagnostics and correction of hemostasis disorders, hemodialysis organization.

[Analysis of efficacy and safety of preventive analgesia with transdermal therapeutic system Duragesic Matrix in spine surgery].

The survey studies analgesic effect of postoperative therapy in two groups of patients with spinal disorders. In the first group the standard scheme with NSAID on demand was used. In the second group transdermal therapeutic system Duragesic Matrix was applied. The pain level (by pain level scale) as well as psychological status and IL-6 rate (a reliable indicator of surgical trauma and pain severity) were assessed before and after surgery. Transdermal therapeutic system Duragesic Matrix applied before surgery appeared to be more effective for analgesic therapy than standard scheme with NSAID on demand.

[Successful experience with xenon anesthesia in a patient with dilated cardiomyopathy and intramedullary spinal cord tumor].

The literature contains rare reports on anesthetic maintenance in non-cardiac operations in patients with dilated cardiomyopathy and an ejection fraction of less than 30%. Life-saving non-cardiosurgical interventions are performed in these patients since they are associated with a high risk for perioperative complications and fatal outcome. In these cases, anesthetic maintenance is performed with inotropic support; there is frequently a need to use a pacemaker, a cardioverter, or a LV assist device. The paper describes the first case of xenon anesthesia in a patient with dilated cardiomyopathy with an ejection fraction of less than 30% and rapidly progressing spinal cord tumor. The ability of xenon to maintain stable blood pressure and cardiac contractility could prevent perioperative infusion of inotropic agents. In 60-70% of cases, the maximum alveolar concentration of xenon enables anesthesia to be virtually performed as monoanesthesia without adding the anesthetics lowering cardiac contractility; the low blood-gas distribution coefficient ensures early emergence from anesthesia with early extubation and activation of a patient. In the author's opinion, xenon anesthesia has every reason to become the method of choice as anesthetic maintenance in patients with severe cardiac dysfunction.

[Epidural anesthesia in surgical interventions on the spine and spinal cord. I. Comparative analysis of the effectiveness of anesthesiological protection under conditions of epidural anesthesia and neuroleptanalgesia in surgery of the spine and and spinal cord]. / Epidural'naia anesteziia pri operativnykh vmeshatel'stvakh na pozvonochnike i spinnom mozge. Chast' I. Sravnitel'nyi analiz adekvatnosti anesteziologicheskoi zashchity v usloviiakh épidural'noi anestezii i neiroleptanal'gezii pri operatsiiakh na pozvonochnike i spinnom mozge.

The study was carried out in 22 patients operated on for vertebral disk hernias and spinal tumors at lumbosacral level. The patients were divided in 2 groups depending on the type of anesthesia (epidural or neuroleptanalgesia-EA and NLA). In the test group all patients were operated under EA with local anesthetics combined with intravenous sedative drugs (diprivan + relanium) under conditions of spontaneous respiration and O2 inhalation through a mask. In the control group combined total intravenous anesthesia by myorelaxants and tracheal intubation were carried out (relanium + diprivan: induction dose 1.95 +/- 0.5 mg/kg, maintenance dose 5.3 +/- 0.4 mg/kg/h, and phentanyl). The purpose of the study was to compare the efficiency of anesthesiological protection under EA and traditional NLA in interventions on the spine, when surgical injury is inflicted in the immediate vicinity to the central structures responsible for pain impulsation. Only EA ensured adequate protection of the patients from surgical stress, as was seen from hemodynamic (arterial pressure and heart rate) and endocrine metabolic parameters (glucose, epinephrine, norepinephrine, hydrocortisone, and prolactin levels). Hence, EA fully demonstrated its protective properties during operations on the spine, and therefore can be regarded as a method of choice in this patient population.

[Epidural anesthesia in surgical interventions on the spine and spinal cord. II. Effects of epidural anesthesia on somatosensory evoked potentials]. / Epidural'naia anesteziia pri operativnykh vmeshatel'stvakh na pozvonochnike i spinnom mozge. Chast' II. Vliianie épidural'noi anestezii na somatosensornykh vyzvannye potentsialy.

Effects of epidural anesthesia (EA) on early components of somatosensory evoked potentials (SSEP) were studied and the objectiveness and efficiency of SSEP monitoring during interventions on the spine under EA were evaluated. Evoked potentials were studied in 21 patients operated on for vertebral disk hernias and extra-intradural tumors of the spine (lower thoracic and lumbar levels) under bupivacaine EA. Cortical SSEP were recorded and analyzed on a Viking IV neuroaverager (Nicolet, USA) stimulating n. tibialis posterior for obtaining a greater amplitude of evoked potentials. The following SSEP characteristics were measured: latency of PI (P37), NI (N45), and PII (P60) peaks, amplitude of PINI peak, and inter-peak latency of PI-NI and PI-PII. The major changes in cortical SSEP caused by EA (local anesthetic 0.5% bupivacaine) involve only PI and NI components which reflect the entry of information on an external stimulus into the cortex and objective physical parameters of this stimulus; this helps predict the onset of full-value epidural block and its duration. General anesthetic (propofol) affect mainly a later component of response, PII peak, which is responsible for processing of primary information about an external stimulus and reflects the activation of associative areas of the brain. Hence, SSEP regulation can be used together with traditional methods (pin prick test and Bromage scale) for evaluating epidural block in patients with spinal diseases.

[Case of uncommon motor reaction to administration of diprivan]. / Sluchai neobychnoi dvigatetel'noi reaktsii na vvedenie diprivana.

A young patient without history of epilepsy developed a pronounced motor reaction simulating an epileptic attack in response to diprivan. Possible causes of motor excitation in response to diprivan and probability of their prediction are discussed.

[The characteristics of epidural analgesia during the removal of lumbar intervertebral disk hernias]. / Osobennosti épidural'noi anal'gezii pri udalenii gryzh poiasnichnykh mezhpozvonkovykh diskov.

Epidural analgesia (EA) was used in 29 patients undergoing surgical removal of lumbar discal hernia. Marcain EA with controlled medicinal sleep and non-assisted breathing allowed to perform the whole operation in 27 patients. EA may be ineffective in combination of sequestrated disk hernia with scarry adhesive process. The technique of the operation demands a single use of the anesthetic drug which is potent enough to make blockade throughout the operation up to the end.