[Features of otosurgery in children after blast injuries]. / Osobennosti rekonstruktivnoi otokhirurgii u detei posle minno-vzryvnykh ranenii.

An explosion is a process that rapidly releases a huge amount of energy in the form of heat, kinetic energy, and high-pressure shock waves. Since the organ of hearing is most susceptible to pressure changes, damage to the sound-conducting or sound-receiving systems is inevitable in case of an explosive injury. This article examines the mechanism of formation of explosive injuries of the middle and inner ear in children and adolescents, the features of diagnosis and tactics of surgical reconstructive treatment of explosive ear injuries based on the data available in the scientific literature and their own experience.

[Experience of transnazal endoscopic surgery of juvenile angiofibroma of the skull base and nasopharynx without performing preoperative embolization]. / Opyt transnazal'noi endoskopicheskoi khirurgii yuvenil'noi angiofibromy osnovaniya cherepa i nosoglotki bez vypolneniya predoperatsionnoi embolizatsii.

Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular, blood-supplied, benign tumour affecting the sinuses, nasal cavity, nasopharynx and the base of the skull. For intraoperative hemostasis, pre-operative embolism is a common and recommended procedure, but it has serious disadvantages, such as additional radiation exposure, anesthesia, and the risk of iatrogenic complications associated with the occlusion of the central artery of the retina, orbital and middle cerebral arteries. This article presents a report on successful radical removal of the widespread SAS without resorting to preoperative embolization, but with intraoperative transnazal endoscopic clipping of the internal maxillary artery (IMA).

[Our first experience with endoscopic ear surgery]. / Opyt primeneniia éndoskopicheskoi tekhniki v otokhirurgii u detei.

INTRODUCTION: For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope. MATERIAL AND METHODS: From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years. RESULTS: Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery. CONCLUSION: In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.

[Lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa in surgery for meningoencephalocele of the lateral sphenoid recess]. / Lateral'nyi rasshirennyi transsfenoidal'nyi éndoskopicheskii dostup cherez krylovidno-nebnuiu iamku v khirurgii meningoéntsefalotsele bokovogo karmana klinovidnoi kosti.

Meningoencephalocele is a hernial protrusion of the medulla and meninges through a defect in the skull bones. Due to poor accessibility of meningoencephalocele located in the lateral sphenoid recess region, modern surgical treatment of this pathology prefers to use endoscopic transsphenoidal approaches. MATERIAL AND METHODS: The study included 4 patients with meningoencephalocele of the lateral recess of the sphenoid sinus (1 male and 3 females; mean age, 46.8 years). All patients underwent resection of meningoencephalocele and repair of a skull base defect using the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach). RESULTS: In all patients, meningoencephalocele was resected to the bone defect level. There was no postoperative liquorrhea. Complications included bacterial meningitis (1 case), asymptomatic imbibition of the temporal lobe pole (1 case), and temporary numbness in the V2 innervation area of the trigeminal nerve (1 case). CONCLUSION: The paper describes and demonstrates advantages of the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach) for surgical treatment of patients with meningoencephalocele of the lateral sphenoid recess.

[A technique of manufacturing anatomical preparations of the human brain based on injecting vessels with colored silicone (a technical note)]. / Sposob izgotovleniia anatomicheskikh preparatov golovnogo mozga cheloveka s in''ektsiei sosudov tsvetnym silikonom (tekhnicheskoe opisanie).

OBJECTIVE: The objective was to produce anatomical preparations by injecting vessels with colored silicone to study the brain and skull base anatomy. MATERIAL AND METHODS: Fresh, undissected, and unfixed cadavers were used. The internal carotid arteries and internal jugular veins were identified on both sides of the neck. The vessels were washed with running water. Then, a complex solution consisting of white silicone rubber, silicone oil (solvent), and a coloring pigment (red and blue pigments) at a ratio of 1:(0.9-1.1):(0.04-0.06), respectively, was prepared. About 30-60 s before injecting the complex solution into the vessels, a catalyst-hardener was added to the solution at a ratio of 1:(0.05-0.07). The complex solution was first introduced into the internal carotid artery until the solution came out from the contralateral internal carotid artery; then, the solution was injected into the internal jugular vein until the solution emerged from the contralateral internal jugular vein. RESULTS: The technique enables quick and high-quality visualization of both large and very small vessels of the brain and skull base. CONCLUSION: The proposed simple and inexpensive technique of manufacturing anatomical preparations improves the quality of training and mastering of microsurgical skills in residents and practicing neurosurgeons.

[Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 2. Topographic and anatomical aspects and surgical technique]. / Éndoskopicheskii éndonazal'nyi zadnii rasshirennyi (transklival'nyi) dostup k opukholiam oblasti skata cherepa i ventral'nykh otdelov zadnei cherepnoi iamki. Chast' 2. Topografo-anatomicheskie aspekty i operativnaia tekhnika.

PURPOSE: to present the main topographic and anatomical features of the clivus and adjacent structures for improving and optimizing the extended endoscopic transnasal posterior (transclival) approach in removal of clival and ventral posterior cranial fossa lesions. MATERIAL AND METHODS: We performed a topographic and anatomical study of 25 cadaver heads, the vascular bed of which was filled with colored silicone using the original technique for visualizing the bed features and individual variability. RESULTS: We present the main anatomical landmarks necessary for performing the extended endoscopic endonasal posterior approach. Superior, medial, and inferior transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa. CONCLUSION: The endoscopic transclival approach can be used to reach ventral posterior cranial fossa lesions. The endoscopic transnasal transclival approach is an alternative to transcranial approaches to clival lesions.

[Polypous pansinusitis with the deformation of the external nose in a 8 year-old child presenting with the primary ciliary dyskinesia syndrome]. / Polipoznyi pansinusit s deformatsiei naruzhnogo nosa u rebenka 8 let s sindromom pervichnoi tsiliarnoi diskinezii.

This article reports a rare observation of the development of chronic polypous pansinusitis with deformation of the external nose in a 8 year-old child presenting with primary ciliary dyskinesia syndrome. The patient underwent multiple surgical interventions in the preceding period. The key argument in favour of the definitive diagnosis was the results of investigation of ciliated epithelium biopsy taken from the nasal cavity and bronchi in combination with the data obtained by diagnostic endoscopy of the nasal cavity and nasopharynx supplemented by computed tomography. The proposed treatment strategy including endoscopic endonasal pansinusotomy, antibacterial therapy taking into consideration the sensitivity of the seeded microorganism, and hormonal therapy proved optimal for the management of the given patient.

[Retromolar mandibular anesthesia. Radiological and topographical study of an additional method of lower teeth anesthesia].

The aim of the study was to estimate the clinical efficacy of mandibular third molars anesthesia with various combinations of local anesthesia methods. Anatomical, radiological and morphological methods were used in the study. The topographic features of retromolar triangle were thoroughly examined. The neurovascular bundle revealed its relationship with retromolar area structures. According to the results of the clinical study the most effective combinations of mandibular third molars analgesia were selected.