[Toward a single inter-disciplinary classification of cranio-cerebral injuries]. / K edinoi mezhdistsiplinarnoi klassifikatsii cherepno-mozgovoi travmy.

The article presents clinical criteria of the diagnosis of concussion, contusion and compression of the brain in the acute period of a craniocerebral injury. The authors specify the major signs of a moderate and deep stun, sopor, as well as moderate, deep and coma de passe. Unified evaluations of the severity of the state of a patient with a craniocerebral injury are described.

[Highway craniocerebral injuries]. / Avtodorozhnaia cherepno-mozgovaia travma.

The work analyses the specific features of the clinical picture, diagnosis, and treatment of craniocerebral injury because of 7 car accidents (225 patients) and in common accidents of everyday life (210 patients). Craniocerebral injury in car accidents is very severe (high incidence of massive and multiple contusions of the brain, fractures of the skull bones, intracranial hematomas) and is often combined with injury to the viscera and bones. Thorough clinical and neurological examination, x-ray of the skull, echoencephalography, cerebral angiography, and trephination of the skull help to disclose and identify exactly the character of the cerebral damage. The therapeutic complex in craniocerebral injury because of car accidents includes measures of intensive therapy and, if indicated, surgical intervention. Traumatism occurring as the result of car accidents is characterized by coarser cerebral functional defects and graver invalidism of patients in contrast to accidents of everyday life.

[Bilateral traumatic subdural hematomas]. / Dvustoronnie travmaticheskie subdural'nye gematomy.

The authors studied 57 verified cases of bilateral traumatic subdural hematomas (BTSH) 36 of which were acute, 4 subacute, and 17 chronic. The patient's ages ranged from 15 to 84 years. The clinical picture of BTSH is made up of general cerebral, primary-focal, and dislocation symptoms. Computerized tomography, serial cerebral angiography, and trephinations formed on both sides help in detection of BTSH. Simultaneous opening of the dura mater on both sides with slow evacuation of the contents of the hematomas is an important stage of surgical intervention in BTSH.

[Secondary craniocerebral trauma in acute disorders of the cerebral circulation]. / Vtorichnaia cherepno-mozgovaia travma pri ostrykh narusheniiakh mozgovogo krovoobrashcheniia.

As many as 69 records were reviewed of those patients predominantly in older age bracket, in whom acute cerebral circulatory disorder (hemorrhage in 26, infarction of the brain in 8, transient cerebral circulatory disturbances in 35) was a cause of their falling and incurring a craniocerebral injury. The studies made suggest that prior history, somatoneurological examination, information provided by various investigational modalities, especially computerized tomographic imaging, all might serve to make the diagnosis of associated brain injury more precise.

[Features of the clinical picture and surgical treatment of traumatic epidural hematomas in different age groups]. / Osobennosti kliniki i khirurgicheskogo lecheniia travmaticheskikh épidural'nykh gematom v razlichnykh vozrastnykh gruppakh.

The authors made a comparative analysis of the clinical course and surgical tactics in traumatic epidural hematomas in children, in young and middle-aged patients, and in patients over 60. Increase in the incidence and severity of concomitant intracranial injuries was noted with an increase in the age of the injured. It was established that general cerebral and secondary-stem syndromes predominate in the clinical picture in children, whereas in elderly and old patients focal disorders are most clearly pronounced and the affection of the stem is of a primary character as a rule. In operations on older patients the cranial cavity must be examined especially thoroughly. Removal of the contusion foci and the use of the inflow-outflow system improves the results of the treatment considerably.

[Arterial aneurysms imitating tumors of the sellar area]. / Arterial'nye anevrizmy, imitiruiushchie opukholi selliarnoi oblasti.

In 3.9% of cases arterial aneurysms took the clinical picture of tumors of the sellar region. The data of the dynamics of the disease, the neurological status, and the findings of ophthalmological, craniographic and pneumoencephalographic examination do not help in establishing the character of the pathological process exactly. To avoid complications consequent upon erroneous determination of the character of the process bilateral carotid angiography should be conducted before surgery in patients with a clinical picture of tumor of the sellar area.

[Clinical picture and diagnosis of mild craniocerebral injuries during alcoholic intoxication]. / Klinika i diagnostika legkoi cherepno-mozgovoi travmy pri alkogol'noi intoksikatsii.

The authors analysed 273 cases with brain contusion suffered in a state of acute alcohol intoxication. It was found that alcohol intoxication alters its clinical picture considerably. The dependence of the neurological symptoms on the degree and phase of alcohol intoxication is shown. Statistical processing of the information obtained allowed the most informative neurological symptoms of brain injury to be revealed. The significance of additional examination methods for the diagnosis is discussed. A dependence of the rheographic indices in brain injury on the phase of concomitant alcohol intoxication is demonstrated.

[Clinical picture, diagnosis and treatment of metastatic melanoma of the brain]. / Klinika, diagnostika i lechenie metastaticheskikh melanoma golovnogo mozga.

The morphological and clinical features of the disease were studied in 73 patients with malanoma metastasis to the brain. A morphological examination revealed predominance of the epithelial-like structure of the tumors over fusocellular, infiltrative growth of metastases in the brain, and many newly formed defective vessels in the metastatic tumors which were conducive to frequent hemorrhages. The clinical picture of the disease was marked by the predominance of general cerebral symptoms over focal. With regard to the diagnosis, much importance is attached to medical history and peculiarities of the clinical manifestations of the disease and to the results of an auxiliary examination (radiocontrast, electrophysiological, etc). Treatment of patients with melanoma metastases in the brain should be combined and should include, whenever indicated, surgical intervention, hormonotherapy, radiotherapy, and chemotherapy.

[Cryosurgery of cerebral arteriovenous aneurysms]. / Kriokhirurgiia arterio-venoznykh anevrizm golovnogo mozga.

The use of stereotaxic cryothrombosis is sparing and sufficiently safe for the management of arteriovenous aneurysms of the brain. On the basis of experience in performing 21 operations on 15 patients, groups of patients for whom the method is recommended are distinguished (with an aneurysm no larger than 6 cm in diameter and up to 35 cm3 in volume). The method is especially promising in the treatment of small deep lying anteriovenous aneurysms. In large aneurysms the considerable blood flow makes it impossible to produce a sufficient hypothermal effect.

[Diagnosis and treatment of chronic traumatic subdural hematomas in middle and old age]. / Diagnostika i lechenie khronicheskikh travmaticheskikh subdural'nykh gematom v pozhilom i starcheskom vozraste.

The peculiar features of the clinical picture, diagnosis, and surgical treatment of chronic traumatic subdural hematomas were studied in 72 patients of elderly and old age. In 98% of patients they occurred after mild craniocerebral trauma of the type of brain concussion. Local signs prevailed over general cerebral signs in all phases of the disease, productive disorders of consciousness were rare as compared to nonproductive disturbances, marked intellectual-mnemonic disorders were often encountered. Echo-EG, radionuclide scintigraphy, carotid angiography and computed tomography proved to be the most informative paraclinical diagnostic methods. The expediency of performing maximally sparing operative intervention of a short duration in individuals over 60 years of age is pointed out.

[Craniocerebral trauma and stroke]. / Cherepno-mozgovaia travma i mozgovoi insul't.

It was demonstrated from analysis of 685 cases that craniocerebral injury is attended by the development of secondary acute disorders of cerebral circulation in 8.9% of cases. Cerebral apoplexy is encountered in craniocerebral trauma 4-5 times more frequently (in 25% of cases) among patients with arterial hypertension and 2-2.5 times more frequently (in 12% of cases) among those with diabetes mellitus than in patients with a nonacerbated somatic anamnesis (in 5.4% of cases).

[The characteristics of closed craniocerebral trauma in older persons]. / Osobennosti zakrytoi cherepno-mozgovoi travmy u lits starcheskogo vozrasta.

It is shown that in the recent 2 decades the incidence of craniocerebral trauma increased from 4.8 to 7.2% among old-aged individuals and from 53 to 72% in the group of patients over 60. The dynamics of changes in the clinical course of mild craniocerebral trauma in 21% of old-aged patients were marked by secondary acute cerebral circulatory disorders which often led to a fatal outcome. Mortality rate in craniocerebral trauma at old age was 52.3%.

[Surgical treatment of contusion foci in different age groups]. / Khirurgicheskoe lechenie kontuzionnykh ochagov u postradavshikh razlichnykh vozrastnykh grupp.

The specific features of surgical treatment of contusion foci in patients of various age groups were studied basing on analysis of 606 cases. Two groups of cases were analysed: those with an isolated brain contusion and cases with contusion and compression of the brain by hematoma and bone fragments. It is shown that removal of the contusion foci in patients of various age groups improves the results of treatment. The patient's age has an essential influence on the choice of surgical tactics in brain contusion.

[The clinico-laboratory criteria of brain death in neurosurgical patients]. / Kliniko-laboratornye kriterii smerti mozga u neirokhirurgicheskikh bol'nykh.

With the purpose of developing scientifically substantiated criteria for brain death complex of clinical and physiological, biochemical, physicochemical, and morphological studies was initiated in 55 patients in a critical state because of a dangerous craniocerebral injury, tumours, and vascular affections of the brain. Generalized in the paper are well-known parameters characterizing irreversibility of changes. The following items are to be regarded as the principal criteria for brain death at the present stage of development of medicine: death of truncus cerebri and irreversibility of metabolic disturbances in brain activity.

[The unified interdisciplinary classification of closed cranio-cerebral trauma]. / O edinoi mezhdistsiplinarnoi klassifikatsii zakrytoi cherepno-mozgovoi travmy.

The article gives an account of the classification of cranio-cerebral traumas recommended by the IIIrd All-Union Congress of Neurosurgeons. Main clinical forms of cranio-cerebral traumas are described: concussion of the brain, contusion of the brain of light, mild and critical degree, compression of the brain against the background of its contusion and without it. A uniform gradation of disturbed consciousness and criteria for the assessment of the patient's state are presented.

[Emergency medical aid to patients with craniocerebral trauma in the prehospital period]. / Neotlozhnaia meditsinskaia pomoshch bolnym s cherepno-mozgovoi travmoi na dogospitalnom étape.

On the basis of analysis of more than 5000 observations of the sufferers admitted to the Kiev Research Institute of Neurosurgery for acute craniocerebral trauma from 1975 to 1991, quality of giving medical aid at the prehospital period was studied. Of most importance, are the measures directed at struggle against respiratory disorders, disturbances in cardio-vascular activity, shock, hemorrhage.

[The characteristics of the diagnosis and clinical course of traumatic hematomas located basally]. / Osobennosti diagnostiki i klinicheskogo techeniia travmaticheskikh gematom bazal'noi lokalizatsii.

The authors analyzed 27 patients with traumatic subdural hematomas of basal location. Hematomas of this location are distinguished by a different clinical course and difficulties of diagnosis. The informative value of different methods of diagnosis is discussed. The method of choice was computerized axial tomography of the brain. Radical surgical treatment is the method of choice.