The osteoplastic flap for pediatric temporal lobe epilepsy treatment: step-by-step guide and technical nuances.

The osteoplastic flap is an under-utilized craniotomy approach in pediatric temporal lobe epilepsy treatment. By preserving the myofascial attachment of the temporalis muscle, the flap is allowed the remain vascularized while subdural and intracranial electrodes are in place. The process in which the flap is made and handled throughout this process can be complicated. We herein detail our surgical technique for the osteoplastic flap in the setting of pediatric temporal lobe epilepsy treatment, and highlight the surgical nuances specific to our 2-stage protocol in treating pediatric temporal lobe epilepsy.

Three-Dimensional Printing of Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [P(3HB-co-3HV)] Biodegradable Scaffolds: Properties, In Vitro and In Vivo Evaluation.

The results of constructing 3D scaffolds from degradable poly(3-hydrosbutyrpate-co-3-hydroxyvalerate) using FDM technology and studying the structure, mechanical properties, biocompatibility in vitro, and osteoplastic properties in vivo are presented. In the process of obtaining granules, filaments, and scaffolds from the initial polymer material, a slight change in the crystallization and glass transition temperature and a noticeable decrease in molecular weight (by 40%) were registered. During the compression test, depending on the direction of load application (parallel or perpendicular to the layers of the scaffold), the 3D scaffolds had a Young's modulus of 207.52 ± 19.12 and 241.34 ± 7.62 MPa and compressive stress tensile strength of 19.45 ± 2.10 and 22.43 ± 1.89 MPa, respectively. SEM, fluorescent staining with DAPI, and calorimetric MTT tests showed the high biological compatibility of scaffolds and active colonization by NIH 3T3 fibroblasts, which retained their metabolic activity for a long time (up to 10 days). The osteoplastic properties of the 3D scaffolds were studied in the segmental osteotomy test on a model defect in the diaphyseal zone of the femur in domestic Landrace pigs. X-ray and histological analysis confirmed the formation of fully mature bone tissue and complete restoration of the defect in 150 days of observation. The results allow us to conclude that the constructed resorbable 3D scaffolds are promising for bone grafting.

Management of paranasal sinus osteomas: A comprehensive narrative review of the literature and an up-to-date grading system.

BACKGROUND: Surgical excision represents the unequivocal treatment modality for symptomatic paranasal sinus osteomas. However, the optimal surgical approach and the extent of the surgery, as well as the management stance in the case of an asymptomatic tumor, remain controversial. METHODS: The MeSH terms 'Osteoma', 'Nasal Cavity', and 'Paranasal Sinuses' were used to retrieve articles concerning the management of paranasal sinus osteomas that were published in the last 30 years, the vast majority of which comprised case reports of one or two cases. Original articles or large series of more than six cases were prioritized. RESULTS: Our review summarizes previous findings and opinions relevant to the management of symptomatic and asymptomatic paranasal sinus osteomas. The recent shifts in trends of their management are thoroughly discussed. Currently, an extension of the lesion through the anterior frontal sinus wall; an erosion of the posterior wall of the frontal sinus; a far-anterior intraorbital extension; an attachment to the orbital roof beyond the midorbital point; and some patient-specific adverse anatomic variations that may restrict access, are considered strong contraindications to a purely endoscopic approach. On the grounds of this thorough review, a new grading system for frontal and frontoethmoidal osteomas is proposed to allow better conformity to recent advancements and current clinical, research, and educational needs. CONCLUSION: Over the past 30 years, endoscopic techniques have emerged as the new standard of care for favorably located paranasal sinus osteomas. Nonetheless, open approaches remain indispensable for the management of the more perplexing cases of frontal sinus osteomas.

Gigantic paranasal sinuses osteomas: clinical features, management considerations, and long-term outcomes.

PURPOSE: Paranasal sinus osteomas are slow-growing, benign bony tumours that when larger than 30 mm, they are termed 'gigantic'. Special considerations apply for tumours of this calibre, and their rarity renders their management fairly controversial. This study seeks to contribute to an increased understanding concerning their management by presenting a 12-year experience from a single institution. METHODS: Retrospective review of files of patients treated for a gigantic paranasal sinus osteoma from January 2008 to December 2019. Additionally, all patients were prospectively reexamined in early 2020 for late complications or clinical recurrence. RESULTS: Ten patients were included, with a mean age of 53.8 years (range: 23-77 years). The leading presenting findings were proptosis (80%) and diplopia (70%). Transient visual impairment was remarkably frequent (30%). Five patients were managed with an open approach, two with an endoscopic, and three with a combined technique. The most common adverse characteristics that dictated the use of an open approach, alone or in combination with an endoscopic approach, were the involvement of the anterior wall of the frontal sinus (40%), erosion of its posterior wall (30%), and a far-anterior intraorbital extension (30%). No major postoperative complications were observed, and also no recurrences. CONCLUSION: Our study illustrates that these tumours may require a different management attitude. Despite substantial advances in the endoscopic management of benign sinonasal tumours, managing these massive tumours solely endoscopically could, in many cases, be inefficacious or impossible. Open approaches remain valuable, representing a safe and straightforward method for adequate exposure.

Endoscopic frontal trephination verse the osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy.

OBJECTIVE: We review the clinical outcome of endoscopic frontal trephination and osteoplastic flap in patients with frontal sinus disease after bifrontal craniotomy. METHODS: The clinical data of patients with frontal sinus disease after bifrontal craniotomy between 2008 and 2018 were studied. RESULTS: Twenty-two patients underwent trephination and 15 patients had osteoplastic flap. The mean operation time was 101.5 min for osteoplactic flap, statistically shorter than that of the trephination (p < 0.05). The blood loss during the trephination was significantly lower than that of the osteoplactis flap (mean, 29.6 ± 11.5 versus 96.3 ± 46.8 ml; p < 0.01). The postoperative hospital stay was 2.2 ± 0.7 days for patients of the trephination and 3.7 ± 1.6 days for patients of the osteoplastic flap, and this difference was statistically significant (p < 0.01). No complication and recurrence in all 37 patients. CONCLUSIONS: Both endoscopic frontal trephination and the osteoplastic flap are safe and highly effective in patients with frontal sinus disease after bifrontal craniotomy. However, the trephination can cause lower blood loss and require shorter postoperative stay while it takes shorter time to complete the osteoplactis flap.

[Skeletal changes due to bone metastases : Morphology and selected differential diagnoses]. / Skelettveränderungen bei Knochenmetastasen : Morphologie und ausgewählte Differenzialdiagnosen.

BACKGROUND: The detection or exclusion of bone metastases is one of the most frequent tasks faced by the radiologist. The decision has significant and long-term consequences for the patient, therapeutic decisions and prognosis. For these reasons, specialized knowledge of the morphology, diagnostics and differential diagnoses of skeletal metastases is essential for the radiologist. OBJECTIVE: The various manifestations of skeletal metastases are elaborated and some representative nonmetastatic differential diagnoses are presented. IMAGING: The way in which metastases are radiologically depicted depends on the primary tumor, the localization of a metastasis, the interaction between metastasis and host bone, concomitant diseases, already initiated treatment and the individual circumstances of the patient. The basis of radiological diagnostics is still projection radiography, albeit with limitations. Computed tomography (CT) and magnetic resonance imaging (MRI) are firmly established methods in diagnostic imaging. Invasive diagnostics, preferably a CT-guided biopsy, are frequently unavoidable. CONCLUSION: Various radiological procedures form the basis of the diagnostics of bone metastases. In many cases a definite diagnosis, i.e. presence or absence of bone metastases, is possible. In cases in which a suspected diagnosis with justified differential diagnoses arises, the radiologist, referring physician and other specialists to be consulted should advise on the benefits, risks and therapeutic consequences of an invasive procedure, usually by CT-guided biopsy.

Influence of the Degree of Deacetylation of Chitosan and BMP-2 Concentration on Biocompatibility and Osteogenic Properties of BMP-2/PLA Granule-Loaded Chitosan/ß-Glycerophosphate Hydrogels.

Compositions based on chitosan/ß-glycerophosphate hydrogels with highly porous polylactide granules can be used to obtain moldable bone graft materials that have osteoinductive and osteoconductive properties. To eliminate the influence of such characteristics as chain length, degree of purification, and molecular weight on a designed material, the one-stock chitosan sample was reacetylated to degrees of deacetylation (DD%) of 19.5, 39, 49, 55, and 56. A study of the chitosan/ß-glycerophosphate hydrogel with chitosan of a reduced DD% showed that a low degree of deacetylation increased the MSCs (multipotent stromal cells) viability rate in vitro and reduced the leukocyte infiltration in subcutaneous implantation to Wistar rats in vivo. The addition of 12 wt% polylactide granules resulted in optimal composite mechanical and moldable properties, and increased the modulus of elasticity of the hydrogel-based material by approximately 100 times. Excessive filling of the material with PLA (polylactide) granules (more than 20%) led to material destruction at a ~10% strain. Osteoinductive and osteoconductive properties of the chitosan hydrogel-based material with reacetylated chitosan (39 DD%) and highly porous polylactide granules impregnated with BMP-2 (bone morphogenetic protein-2) have been demonstrated in models of orthotopic and ectopic bone formation. When implanted into a critical-size calvarial defect in rats, the optimal concentration of BMP-2 was 10 µg/mL: bone tissue areas filled the entire material's thickness. Implantation of the material with 50 µg/mL BMP-2 was accompanied with excessive growth of bone tissue and material displacement beyond the defect. Significant osteoinductive and osteoconductive properties of the material with 10 µg/mL of BMP-2 were also shown in subcutaneous implantation.

Use of three-dimensional printing for the osteoplastic flap approach: A viable technique.

The osteoplastic flap technique is the open and direct approach to the frontal sinus and is especially useful when disease extends laterally into the frontal sinus. One of the vital steps of surgery is delineation of the boundary of the frontal sinus. This can usually be performed either by using the classical 6-ft Caldwell view X-ray template or more recently by application of the image-guided navigation system. The present article describes an alternative technique of using 3D printing technology for preoperative creation of the onlay template to mark the limits of the frontal sinus during osteoplastic flap technique and its advantages.

[Obliteration of the middle ear cavity in children: the current state of the problem and our first experience]. / Obliteratsiya polostei srednego ukha u detei: sovremennoe sostoyanie problemy i nash pervyi opyt.

Chronic otitis media is one of the most common ear pathologies among children. This article provides a short overview of publications on surgical techniques. Currently, the most effective treatment is the surgical sanitation of the middle ear cavities. There are two fundamentally different approaches of operations in relation to the posterior wall of the external auditory canal - «open¼ and «closed¼ types. Both methods have their advantages and disadvantages, which are especially noticeable in pediatric revision otosurgery. Surgical obliteration of the sanitized middle ear cavities is an effective compromise option. However, the techniques of bone obliteration, which are actively applied among adults, are difficult if we discuss children ear. A way out of this situation may be the use of modern osteoplastic materials for filling large trepanation cavities. The article describes in detail the technique of revision sanitizing surgery on the middle ear using osteoplastic granules. Purpose of the study. The analysis of the first results of separate obliteration of paratympanic cavities in children using osteoplastic materials. MATERIAL AND METHODS: In the period from May 2018 to November 2020, on the basis of the Federal State Autonomous Institution «National Medical Research Center of Children's Health¼ of the Ministry of Health of Russia, 28 children aged from 6 to 17-year-old with chronic otitis media and cholesteatoma were operated using osteoplastic obliteration, who had previously sanitizing operation on the middle ear. All children on admission to the hospital and 6-12 months after the operation underwent a complex examination. The condition of each patient was assessed using the OMO-22 quality of life questionnaire, to which the parents answered the questions twice - before and 1 year after surgery. RESULTS: During the postoperative period none of the patients had clinical signs of recurrence of cholesteatoma, which was confirmed by CT scan. When assessing the quality of life of children using a questionnaire, the average score before the operation was 130.2±27.7, after the operation - 61.5±21.1. The indicator of the bone-air interval before surgery in patients averaged 29.8±9.7 dB, 1 year after surgery - 13.0±10.9 dB (p>0.05). FINDINGS: The first experience of using osteoplastic materials for obliterating the paratympanic spaces in children has shown high efficiency, ease of use and safety.

Pediatric functional hemispherectomy: operative techniques and complication avoidance.

Functional hemispherectomy/hemispherotomy is a disconnection procedure for severe medically refractory epilepsy where the seizure foci diffusely localize to one hemisphere. It is an improvement on anatomical hemispherectomy and was first performed by Rasmussen in 1974. Less invasive surgical approaches and refinements have been made to improve seizure freedom and minimize surgical morbidity and complications. Key anatomical structures that are disconnected include the 1) internal capsule and corona radiata, 2) mesial temporal structures, 3) insula, 4) corpus callosum, 5) parietooccipital connection, and 6) frontobasal connection. A stepwise approach is indicated to ensure adequate disconnection and prevent seizure persistence or recurrence. In young pediatric patients, careful patient selection and modern surgical techniques have resulted in > 80% seizure freedom and very good functional outcome. In this report, the authors summarize the history of hemispherectomy and its development and present a graphical guide for this anatomically challenging procedure. The use of the osteoplastic flap to improve outcome and the management of hydrocephalus are discussed.

[Chitosan hydrogels biocompatibility improvement with the perspective of use as a base for osteoplastic materials in dentistry]. / Povyshenie biosovmestimosti khitozanovykh gidrogelei s perspektivoi ikh ispol'zovaniya v kachestve osnovy dlya kostno-plasticheskikh materialov v stomatologii.

Using chitosan as the basis for osteoplastic material, we were dealt with its low biocompatibility. The critical assessment of it is poorly presented in the literature and does not have systematic approaches to solving. The aim of the study was to determine the effect of factors affecting chitosan charge and its free amino groups number on the biocompatibility of hydrogels. Biocompatibility of chitosan compositions were studied in male Wistar rats (n=90). The subcutaneous implantation of chitosan discs and hydrogel caused abundant leukocyte infiltration. The addition of ß-glycerophosphate followed by dialysis slightly reduced the inflammatory response. Treatment with a solution of alkali NaOH and NaHCO3 buffer, on the contrary, intensified the inflammatory response. It is confirmed the effect of charged amino groups of chitosan on leukocyte taxis A decrease in the deacetylation degree (DD) of chitosan to 39.0% led to a statistically significant decrease in leukocyte infiltration. Saturation of chitosan hydrogels with PLA granules reduced by 16% the level of leukocyte infiltration, which was supposedly associated with a decrease in the volume of the hydrogel and an increase in the area of its interaction with blood plasma proteins, which reduce the positive charge of chitosan. The most significant reduction in leukocyte infiltration was achieved with a combination of deacetylated to 39.0% chitosan hydrogel with the addition of 16% by weight highly porous PLA granules.

[Dynamics of bone metabolism markers in oral fluid after surgical treatment of chronic periodontal disease with various osteoplastic materials]. / Dinamika kostnogo metabolizma posle khirurgicheskogo lecheniia khronicheskogo generalizovannogo parodontita s podsadkoi razlichnykh kostno-plasticheskikh materialov po pokazateliam rotovoi zhidkosti.

The aim of the work was to assess the balance between osteosynthetic and osteodestructive processes in the oral cavity in patients with chronic generalized periodontitis (CGP) of moderate and severe severity in the dynamics of a remote period of patchwork using various bone-plastic materials (BPM) based on xenogeneic hydroxyapatite (HA), ß-tricalcium phosphate (TCP). 123 patients with CGP were examined. Depending on the type of BPM, two groups were distinguished by composition in the course of patchwork operations. Patients of group 1 (n=61) received BPM on the basis of xenogeneic HA, 2 groups (n=62) on the basis of ß-TCP. Initially and after surgery at 8 and 12 months in the oral fluid, the concentration of osteoprotegerin (OPG), the ligand of the soluble activator of the kappa B nucleation factor (sRANKL), the bone isoenzyme of alkaline phosphatase (BAP), was determined by an immunoenzyme method. As a result of the study, it was found that in patients with moderate-bodied CGP after surgical treatment, restriction of osteoclast activity with a decrease in sRANKL due to an increase in OPG in the oral fluid, an increase in osteoblast activity with BAP secretion is most pronounced when using ß-TCP-based BPM at 8 months. After surgery with an average severity of the disease. Less pronounced changes in bone metabolism in the oral cavity are detected with the use of BPM on the basis of HA. In severe CGP, changes in bone homeostasis in the oral cavity after scrappy operations with BPM insertion based on TCP or HA are not expressed and are observed only after 12 months. Thus, the most effective changes in bone metabolism develop with the use of TCP as BPM.

[Biocompatibility and osteoinductive properties of collagen and fibronectin hydrogel impregnated with rhBMP-2]. / Biosovmestimost' i osteogennye svoistva kollagen-fibronektinovogo gidrogelya, impregnirovannogo BMP-2.

The study aimed to demonstrate the biocompatibility and osteoinductive properties of a hydrogel based on highly purified collagen and fibronectin impregnated with rhBMP-2. In vitro and in vivo experiments have shown that the minimum effective dosage of rhBMP-2 is 10 µg/ml. The cytocompatibility of the collagen-fibronectin gel was determined using MTT test and staining with PKH-26. There was no inflammation reaction when the material was subcutaneously implanted in rats (n=30) in vivo. The collagen-fibronectin hydrogel containing 10 µg/ml rhBMP-2 showed high osteogenic properties. By the end of 28 days 8±4% of its volume was replaced by newly formed bone tissue in case of subcutaneous implantation, 17±10% in intramuscular implantation and 26±11% in intraosseous implantation in the calvarial critical-size. The optimal combination of biocompatible and osteogenic properties of collagen-fibronectin hydrogel impregnated with BMP-2 allows us to consider it as a promising basis for creating the new generation of osteoplastic materials for dentistry.

[The prospects of collagen as a basis for curable and activated osteoplastic materials]. / Perspektivy ispol'zovaniia kollagenovogo gidrogelia v kachestve osnovy dlia otverzhdaemykh i aktivirovannykh kostno-plasticheskikh materialov.

In the review, the structure and biological properties of collagen, variants of its production from natural sources and purification are considered. Methods for modifying the physico-mechanical properties of collagen to create a curable, highly purified collagen hydrogel are described. The advantages of a cured highly purified collagen hydrogel as a basis for osteoplastic material and a means of delivery of growth factors are indicated. The registered osteoplastic materials based on the curable highly purified collagen hydrogel are described, and their comparative analysis is carried out. On the basis of the obtained data, a conclusion was made about the prospects of using collagen as a basis for curable and activated osteoplastic materials.

[Differences in the cytocompatibility of bone-plastic materials from xenogeneic hydroxyapatite with stem cells from human exfoliated deciduous teeth and adipose tissue-derived mesenchymal stem cells]. / Razlichiia tsitosovmestimosti kostno-plasticheskikh materialov iz ksenogennogo gidroksiapatita s mul'tipotentnymi mezenkhimal'nymi stromal'nymi kletkami, poluchennymi iz pul'py vypavshikh molochnykh zubov i podkozhnogo lipoaspirata.

AIM: To compare the cytocompatibility of osteoplastic materials used in dentistry with stem cells from human exfoliated deciduous teeth (SHED) and adipose tissue-derived mesenchymal stem cells (AD-MSC). MATERIAL AND METHODS: Materials of the brands 'Bio-Oss', 'Indost', 'Bioplast', 'Viscoll' and 'Trikafor' were selected for study purposes. Cultures of SHED and AD-MSC were used for testing. The cytotoxic effect of the materials was determined using MTT test and vital staining with trypan blue. Cell adhesion was assessed by the vital staining of PKH-26. RESULTS: Water extracts of bone-plastic materials from xenogeneic hydroxyapatite of the brands 'Bio-Oss', 'Indost' and 'Bioplast' exert a cytotoxic effect on SHED and do not cause the death of AD-MSC. Materials based on collagen and ß-tricalcium phosphate possess high cytocompatibility with all cell cultures under study. CONCLUSION: From the point of cytocompatibility all the examined bone-plastic materials may be considered safe for the restoration of bone defects. It should be noted that SHED transplantation on the surface of materials containing xenogeneic hydroxypatite is unacceptable.

Osteocutaneous bone flap - a useful variant of the osteoplastic flap in pediatric patients.

Traditional teaching describes two types of bone flaps in craniotomies - 'free bone flap' and osteoplastic craniotomies. While in the former, the entire bone flap devoid of soft tissue attachments is removed, in the latter the bone flap that is turned is hinged on a pedicle of temporalis muscle with the aim of retaining its vascular supply. We describe a variant of the latter in 13 pediatric patients in whom the lower margin of the craniotomy was above the attachment of the temporalis muscle and where the bone flap was lifted with all the layers of the scalp including the skin and galea, highlighting the thought process behind its performance and the advantages of the same.

Professor Sergei Semjonovic Golovin (1866-1931): A Pioneer of Ocular Surgery.

Professor Sergei Semjonovic Golovin (1866-1931) is considered as one of the founders of ophthalmology in Russia. He received a worldwide reputation thanks to his achievements in ocular surgery and pathology. He introduced new surgical techniques such as Golovin's operation (Exenteratio orbitosinualis), Golovin's osteoplastic frontal sinus operation, ligation of orbital veins, and opticociliary neurectomy. He also introduced his "cytotoxic theory" to interpret sympathetic ophthalmia. He was a reputable professor of ophthalmology.

Experimental Validation of the Efficiency of Gamalant-paste-FORTE Plus, a Russian Osteoinductive Material, in Oral Surgery.

For evaluation of the efficiency of bone substitute, nanostructurized Gamalant-paste-FORTEPlus was placed into a mandibular defect in rats. Bone tissue reparation was evaluated after 30 days by histological methods under a microscope. Use of bone substitute in experimental mandibular defect ensured more complete and rapid restructuring of the bone tissue in comparison with the control (natural healing).

[The prospects of hydrogels usage as a basis for curable osteoplastic materials]. / Perspektivy ispol'zovaniia gidrogelei v kachestve osnovy dlia otverzhdaemykh kostno-plasticheskikh materialov.

The article deals with the main types of the polymers used in hydrogel preparation. Their biological, physical and chemical properties was compared. Ways of polymers hardening and prospects of medical application were considered. The prospect of use of chitosan hydrogels activated by osteoinductors as a material for bone augmentation were concluded.

[The differential approach to the surgical treatment of pathologies of the frontal sinus]. / Differentsirovannyi podkhod k khirurgicheskomu lecheniiu patologii lobnoi pazukhi.

The surgical intervention for the management of frontal sinusitis is required in a large fraction of patients presenting with this condition. The treatment of choice for the pathology in question is endoscopic endonasal frontotomy. Whenever the endoscopic technique is impossible to employ, the surgeon has to resort to an extranasal operation on the frontal sinus. The indications for the application of such strategy include the pathological conditions complicated by the intracranial and orbital processes, the presence of large benign tumours, recurrent post-surgical purulent sinusitis and traumatic frontal sinusitis. For the preservation of the functionally competent frontal sinus during extranasal frontotomy, a frontonasal fistula with all bony walls and maximally spared mucous membrane can be created. In order to remove an osteotoma from the frontal sinus, we applied the osteoplastic approach with the formation of the osteo-periosteal flap from the frontal wall of the sinus. In those cases when it was impossible to restore the frontal sinus and there was a closed bone cavity undergoing purulent inflammation we practiced obliteration of the cavity with the use of a porous carbon implant.