[Dysphagia as the main symptom in anterior cervical spine osteophytes (Forestier disease and cervical spondylosis deformans). Case reports and literature review]. / Disfagiya kak osnovnoi simptom pri perednikh osteofitakh sheinogo otdela pozvonochnika (bolezn' Forest'e i tservikal'nyi deformiruyushchii spondilez): obzor literatury i analiz klinicheskikh sluchaev.

Anterior cervical osteophytes are a fairly common X-ray finding in people over 50 years old. Incidence of dysphagia in patients with anterior osteophytes varies from 1% in those aged 40-60 years to 10.6% in patients over 60 years old. The most common causes of anterior cervical hyperosteophytosis causing dysphagia are cervical spondylosis deformans and Forestier disease. We present 2 clinical cases of spondylogenic dysphagia in cervical spondylosis deformans and Forestier disease. The review is devoted to the causes and diagnostic methods for dysphagia caused by anterior cervical osteophytes, as well as surgical options for this pathology. CONCLUSION: Microsurgical resection of anterior osteophytes is an effective method for dysphagia after ineffective therapy for 3 months. Microsurgical osteophytectomy provides stable regression of dysphagia with low recurrence rate.

[Quality of life in patients with hemifacial spasm after microvascular decompression and botulinum toxin therapy]. / Otsenka kachestva zhizni patsientov s gemifatsial'nym spazmom posle mikrovaskulyarnoi dekompressii i botulinoterapii.

To date, microvascular decompression (MVD) and botulinum therapy (BT) confirm own efficacy in the treatment of hemifacial spasm (HFS). Quality of life (QOL) suffers first of all in these patients. Therefore, the dynamics of QOL indicators determines postoperative outcomes. Various researchers have proposed specialized scales for assessing QoL in HPS patients (HFS-7, HFS-8, HFS-30). OBJECTIVE: To analyze QOL in patients with HPS before and after MVD and BT including HFS-7 score and regression of HFS. MATERIAL AND METHODS: We analyzed data of patients (n=80) divided into two groups: group I - MVD of the facial nerve (n=66), group II - BT (n=14). Mean age of patients was 52.4 (range 28-76) and 58.1 years (range 23-73), respectively. QOL was assessed using a questionnaire enrolling clinical and anamnestic data, as well as HFS-7 scale. Clinical severity of HFS and effect on daily activity were assessed using the Tan scale. We analyzed the results of MVD and BT considering clinical improvement (regression of spasm) and HFS-7 score. A four-level gradation of clinical regression of spasm was used. RESULTS: Patients with mild course of disease and higher QOL prefer BT. In our sample, 3 (21%) patients from the 2nd group preferred surgery a year after BT, and 13 (20%) patients from the 1st group had previously undergone BT in other hospitals. Changes in HFS-7 score before and after treatment were significant in both groups (p<0.005, t-test). Spearman's coefficient (R= -0.66) shows the correlation between clinical effect and HFS-7 score. CONCLUSION: MVD and BT significantly improve QOL in patients suffering from HFS. Patients with less severe hemispasm prefer BT, but conversion to surgery is possible as disease progresses. Both treatment methods should be available for HFS patients. Treatment outcomes should be assessed using specialized scales designed for HFS.

[Microvascular decompression in trigeminal neuralgia following vertebrobasilar dolichoectasia]. / Mikrovaskulyarnaya dekompressiya pri nevralgii troinichnogo nerva vsledstvie vertebrobazilyarnoi dolikhoektazii.

OBJECTIVE: To analyze our own results with literature data and substantiate microvascular decompression in patients with trigeminal neuralgia (TN) following vertebrobasilar dolichoectasia (VBD). MATERIAL AND METHODS: A total of 504 patients with TN underwent surgery in 1998-2018. Patients with TN following VBD were included into a retrospective study. There were 4 men and 10 women aged 66 years (range 51-80). Outcomes were evaluated using BNI (Barrow Neurological Institute) scale. PubMed database was used for literature review. RESULTS: TN caused by VBD was diagnosed in 2.8% of patients. Left-sided trigeminal pain was observed in 10 patients, right-sided - in 4 cases. One patient had concomitant hemifacial spasm. MVD followed by shielding of trigeminal nerve root with shredded Teflon was performed in all patients. We did not perform fixation of vertebrobasilar vessels. In one case, open partial trigeminal nerve root rhizotomy was done in addition to MVD. All patients had pain-free early postoperative period. There were no deaths or major complications. There was transient cranial nerve dysfunction lasting no more than three months (facial numbness - 1, IV nerve dysfunction - 1, VI nerve dysfunction - 1, transient partial facial palsy (House-Brackmann II) - 2, hipoacusia - 2 patients). There was no facial pain recurrence in our group. Mean follow-up period was 5.5 years (range 6 months - 16 years). CONCLUSION: MVD is an effective option in the treatment of TN following VBD. In these cases, operation is technically more difficult compared to MVD with intact vessels. However, surgery is much more effective than all the available alternatives. The possibilities of vessel transposition in VBD with or without fixation are limited and ineffective. Teflon wool interposition at the points of conflict is an effective and sufficient technique.

[Venous compression as a cause of trigeminal neuralgia]. / Venoznaya kompressiya kak prichina nevralgii troinichnogo nerva.

AIM: The study objective was to verify venous compression as a cause of trigeminal neuralgia (TN) and to define the optimal surgical tactics for TN patients. MATERIAL AND METHODS: Four hundred twenty one patients were operated on for TN at the Neurosurgical Department of the City Hospital №2 from 1998 to 2015. Veins in the trigeminal nerve root entry zone, as a significant compression factor, were identified in 40 patients (9.5%). Intraoperative data, questionnaires, and self-assessment inventories were analyzed. Treatment outcomes were assessed using the Barrow Neurological Institute (BNI) scale. RESULTS: Patients with venous compression were divided into two groups. Eleven (27.5%) patients in the first group had isolated venous compression. The feature of microvascular decompression (MVD) in these patients was identification of all veins, vein mobilization, and, if possible, vein coagulation and resection. Resection of the vein along its course is a basic procedure to avoid recurrent neuralgia. The second group included 29 (72.5%) patients with a combination of venous and arterial compression. In these patients, a vein acted as an "assisting" compression factor: the vein changed the course of a compressing artery or nerve and exerted an additional compression effect on the nerve. The surgical tactics involved exploration of the trigeminal nerve root entry zone, arterial loop mobilization, and placement of a Teflon protector; venous vessels were coagulated and resected. The MVD efficacy was as follows: in group 1, 10 patients had a BNI score I-III, and 1 patient had a BNI score IV; in group II, 25 patients had a BNI score I-III, and 4 patients had a BNI score IV. CONCLUSION: Venous compression can play both independent and assisting roles in the TN genesis. When exploring the trigeminal nerve, examination of the proximal trigeminal nerve is of particular importance, with paying attention to veins that may be a compression factor. In the case of isolated venous compression, the MVD surgical technique has some peculiarities, in particular coagulation and resection of veins compressing the trigeminal nerve root entry zone.

[Pseudomeningocele with spinal cord compression following removal of meningioma at the Th3-Th4 level: a case report].

Pseudomeningocele is an abnormal extradural collection of the cerebrospinal fluid in soft tissues, communicating with the arachnoid space through a dural defect. Postoperative pseudomenigocele of the thoracic spine presenting with myelopathy is a rare phenomenon; we found only two such cases in the literature. A clinical case of a female patient operated on for meningioma at the Th3-Th4 level with postoperative pseudomenigocele and spinal cord compression is presented.

[Analysis of the neurological status and functional outcome after facial nerve neuroplasctics using accessory nerve]. / Analiz nevrologicheskogo statusa i funktsional'nogo iskhoda posle neiroplastiki litsevogo nerva.

AIM: to assess effectiveness of mimic muscles rehabilitation after cross neuroplastics using accessory nerve (AN) by neurological scales estimating functional outcome. MATERIAL AND METHODS: During 1998-2010 20 patients underwent cross neuroplastics of facial nerve (FN) by a main trunk of AN. The average follow-up was 4.65 years (1-10 years). At baseline all patients had total function loss of FN after excision of acoustic neuroma. The interval between function loss and surgery was 1-6 months (4.7 months in average). Patients were within age range 37-73 years (51.8 years in average). Each patient was accessed by clinical scales House-Brackmann Facial Grading Systems (HB) and Yanagihara system (YS) for estimation of the extent of mimic paresis. Sunnybrook Facial Grading scale (SFG) was used to assess facial symmetry and synkineses. Self-assessment questionnaire Facial Disability Index (FDI) was also used. Original questionnaire, Shoulder Disability Index (SDI), including 4 questions was used for self-assessment of a denervated shoulder segment (maximum 100 degrees). RESULTS: 4 patients (20%) recovered up to HB II, 11 (55%) - up to HB III and 5 (25%) - up to HB IV-V. Average degree by YS was 27.5±4.06, average SFG was 71.1±9.38. Average degree by self-assessment (FDI) was 143.75± 22,82, and average SDI was 69.06± 22.16. All acquired data was statistically analyzed and compared. Strong correlation (r= -0.72, p< 0.001) was found between magnitudes of HB, YS and SFG after surgery, and between total FDI and SDI (r=0.56, p<0.001). CONCLUSION: Results of cross neuroplastics of FN using AN are compatible with those in other neuroplastic techniques and improve patients' quality of life. This procedure is acceptable for rehabilitation of FN function after surgery of skull base. The main problem of assessment of mimic muscles is subjectivism, that is why clinical scales and self-assessment questionnaires have to be used. After cross neuroplastics denervated segment of shoulder should be assessed by the specialized scale.

[Long-term results of microvascular decompression in treatment of hemifacial spasm].

BACKGROUND: Aim of the study was to assess results of treatment and quality of life of patients with hemifacial spasm (HFS) after microvascular decompression and to analyze intraoperative data in surgical revision of intracranial portion of facial nerve. MATERIALS AND METHODS: The study included 30 patients with HFS who underwent microvascular decompression. Duration of symptoms varied between 1 and 30 years (mean--6.7 years). Typical manifestation of spasm was observed in 28 cases, atypical--in 22. Severity of HS and its influence on everyday activity were assessed using 5-grade scale (by E. Tan), and surgical results--according to degree of clinical improvement combined with evaluation of quality of life using scale HFS-7. RESULTS. Most frequent type of conflict observed in the series was contact between facial nerve and AICA (64.4%). Compression of facial nerve root entry zone was revealed in vast majority of cases (93.3%), and in 2 patients (6.7%) site of compression was distal to the root entry zone. In a female patient with secondary HFS due to the tumor relations of neurovascular structures were altered and their displacement produced conflict between AICA loop and facial nerve. In our series hearing depression of different severity was observed in 16.7% of patients. This disorder is persistent and does not regress in the follow-up period. All other symptoms of cranial nerve dysfunction are amenable to resolve within 1-2 months. CONCLUSION: Microvascular decompression of facial nerve is pathogenetically feasible and effective method of treatment of HFS. It allows achievement of consistent regression of symptoms and improvement of quality of life of patients with HFS.