[Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 1. Topographic and anatomical features of the clivus and adjacent structures]. / Éndoskopicheskii éndonazal'nyi zadnii rasshirennyi (transklival'nyi) dostup k opukholiam oblasti skata i ventral'nykh otdelov zadnei cherepnoi iamki. Chast' 1. Topografo-anatomicheskie osobennosti skata i pogranichnykh s nim obrazovanii.

OBJECTIVE: to describe the main topographic and anatomical features of the clival region and its adjacent structures for improvement and optimization of the extended endoscopic endonasal posterior (transclival) approach for resection of tumors of the clival region and ventral posterior cranial fossa. MATERIAL AND METHODS: We performed a craniometric study of 125 human skulls and a topographic anatomical study of heads of 25 cadavers, the arterial and venous bed of which was stained with colored silicone (the staining technique was developed by the authors) to visualize bed features and individual variability. Currently, we have clinical material from more than 120 surgical patients with various skull base tumors of the clival region and ventral posterior cranial fossa (chordomas, pituitary adenomas, meningiomas, cholesteatomas, etc.) who were operated on using the endoscopic transclival approach. RESULTS: We present the main anatomical landmarks and parameters of some anatomical structures that are required for performing the endoscopic endonasal posterior approach. The anatomical landmarks, such as the intradural openings of the abducens and glossopharyngeal nerves, may be used to arbitrarily divide the clival region into the superior, middle, and inferior thirds. The anatomical landmarks important for the surgeon, which are detected during a topographic anatomical study of the skull base, facilitate identification of the boundaries between the different clival portions and the C1 segments of the internal carotid arteries. The superior, middle, and inferior transclival approaches provide an access to the ventral surface of the upper, middle, and lower neurovascular complexes in the posterior cranial fossa. CONCLUSION: The endoscopic transclival approach may be used to access midline tumors of the posterior cranial fossa. The approach is an alternative to transcranial approaches in surgical treatment of clival region lesions. This approach provides results comparable (and sometimes better) to those of the transcranial and transfacial approaches.

[Sonoelastography in differential diagnosis of thyroid nodes].

The study was aimed to assess the diagnostic possibilities of the new method of sonoelastography. 68 patients with different thyroid nodes were studied. Sonoelastography increased the sensitivity of the routine ultrasound investigation from 89 to 94.8%, the specificity from the 83 to 93%, and the accuracy of the method from 76 to 89%. The method assignes the information of the structural changes of the thyroid, unavailable by the routine ultrasound investigation.

[Prognosis of the course of complicated ulcer disease and mortality in aged and senile patients]. / Prognoz techeniia oslozhnennoi iazvennoibolezni i letal'nosti u bol'nykh pozhilogo i starcheskogo vozrasta.

The developed system for forecasting the course of the disease in elderly and senile patients made it possible to distinguish two variants of the ulcer course: favorable and unfavorable. Its application confirmed that it is possible to use the forecast evaluation system in studies of remote results. In case of an unfavorable forecast, this provides the ground for urgent recommendations for surgical treatment in this group of patients without waiting for life-threatening complications to develop.