[Diagnosis and surgical outcomes in the management of petrous bone cholesteatoma]. / Diagnostika i effektivnost' khirurgicheskogo lecheniya kholesteatomy piramidy visochnoi kosti.

OBJECTIVE: To evaluate the effectiveness of surgical treatment of patients with petrous bone cholesteatoma (PBC) depending on the localization of the pathological process. MATERIAL AND METHODS: The analysis of surgical treatment using various surgical approaches and its results in 32 patients with PBC, depending on the type, localization in petrous bone and intraoperative findings, is presented. Patients with supralabirint PBC underwent extended atticoantromastoidotomy with tympanoplasty and mastoidoplasty with automaterials (n=19), labyrinthectomy (n=4), subtotal petrozectomy with labyrinthectomy and suturing of the external auditory meatus (EAM) (n=2). In infralabirint and infralabirint-apical PBC, a transotic approach was used with Rambo suturing of EAM (n=9). The pre-sigmoid approach was performed in 1 patient. With an extradural subtemporal approach, PBC of apical localization was removed in 1 case. RESULTS: After surgical treatment, hearing remained at the same level in 15 (47%) patients, 14 of them had deafness. In the early postoperative period, a temporary increase in bone conduction hearing thresholds by 10-20 dB was detected in 14 (44%) patients with their gradual recovery over 3 months. Deafness in the postoperative period developed in 3 (9%) patients after removal of supralabirint cholesteatoma. In the early postoperative period, 3 (9%) patients developed systemic dizziness, which was stopped after 3 months. In 25 (78%) patients, the function of the facial nerve in the early postoperative period remained at the same level, of which 14 (44%) were normal, and 11 (34%) had the same degree according to the House-Brackmann (HB) classification. Improvement of function by one degree of HB classification was observed in 4 (12.5%) patients on average 5 months after surgery. CONCLUSION: An adequate personalized choice of surgical treatment methods allowed mainly to preserve the function of hearing and facial nerve. In cases of deterioration of facial nerve function in the postoperative period, gradual improvement was observed for 3-10.5 months with further positive dynamics.

[Case of diagnosis and surgical treatment of intracranial cholesteatoma]. / Sluchai diagnostiki i khirurgicheskogo lecheniya intrakranial'noi kholesteatomy.

The article provides a brief overview of the epidemiology of congenital and acquired intracranial cholesteatoma, the theory of its pathogenesis, classification, and clinical features. The most common localization of congenital and acquired intracranial cholesteatoma is described and various surgical approaches are presented that allow total removal of the formation. A clinical case of diagnosis and surgical treatment of acquired intracranial cholesteatoma caused by chronic suppurative otitis media is presented. A clinical example indicates the possibility of a long asymptomatic course of acquired intracranial cholesteatoma. The use of a combined (extradural subtemporal and transmastoid) surgical approach made it possible to completely remove the acquired cholesteatoma of the temporal lobe of the brain in a patient with chronic suppurative otitis media.

[Congenital cholesteatoma of the mastoid process: cases of diagnosis and surgical treatment]. / Vrozhdennaya kholesteatoma sostsevidnogo otrostka visochnoi kosti: sluchai diagnostiki i khirurgicheskogo lecheniya.

A brief review of the epidemiology and pathogenesis of congenital cholesteatoma (CC) of the temporal bone pyramid is presented, classifications reflecting the degree of spread or localization of the process are considered. Variants of local CCs of the mastoid process don't fit into these classifications, as well as there is no statistics on the frequency of their detection and treatment due to the rarity of this pathology. Clinical cases of diagnosis, surgical treatment of CC of the mastoid process and its results are described. Clinical examples indicate a long-term asymptomatic course of CC of the mastoid process, accompanied by a pronounced destructive process in the mastoid process. Early surgical treatment makes it possible to remove the neoplasm as radically as possible and preserve hearing function.

[Acoustic neurinomes of childhood]. / Nevrinoma preddverno-ulitkovogo nerva u detei.

The article presents a review of the literature on the vestibular schwannoma of childhood, the features of its clinical manifestations, diagnostic methods, methods of treating education and indications for their use.

[A case of diagnostics and surgical treatment of a patient with a neuroma of the facial nerve]. / Sluchai diagnostiki i khirurgicheskogo lecheniya patsienta s nevrinomoi litsevogo nerva.

The article provides a brief overview of the epidemiology of facial nerve neuromas (FNN, schwannomas), its clinical signs, methods of diagnostic and treatment and indications for their use. A rare clinical case of diagnostics, surgical treatment of FNN with intracranial spread and its results are described in detail. The presented case demonstrates a possible low-symptom course of FNN with intracranial spread. The use of a combined surgical approach (translabyrinthine and extradural subtemporal) in conjunction with neurosurgeons makes it possible to remove FNN with intracranial spread with simultaneous intratemporal neuroplasty of the nerve trunk from the tympanic part of the canal to the bottom of the internal auditory canal with a fragment of the sural nerve with an improvement in the function of the affected nerve.

[HYPOTHERMIA INFLUENCES ON OXYGEN TENSION IN THE BRAIN PARENCHYMA IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE].

Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself

[The surgical treatment of cholesteatoma of the pyramid of the temporal bone].

This paper presents in brief the data on epidemiology, classification, diagnostics, and current tendencies in the surgical treatment of cholesteatoma of the pyramid of the temporal bone. A clinical case of diagnostics and the surgical treatment ofpetrous apex cholesteatomainthe temporal bone is described.