Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section.

BACKGROUND: The optimal management of clinoidal meningiomas (CMs) continues to be debated. METHODS: We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. RESULTS AND CONCLUSION: This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient's counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.

[INFLUENCED ARBEPOETINALFA TO REDUCE THE NUMBER OF BLOOD TRANSFUSION IN CHILDREN WITH NON-SYNDROMIC CRANIOSYNOSTOSIS.]

BACKGROUND: According to the literature, the prevalence of non-syndromic forms of craniosynostosis in children is very high. Given that the treatment of this pathology and surgery performed only at an early age of the child, the need for transfusion arise very often. THE AIM: To study the efficacy ofpreoperative use of darbepoetin alfa in combination with intraoperative normovolemic hemodilution to reduce the number of blood transfusions during surgery and in the early postoperative period. MATERIALS AND METHODS: The study included 70 children between the ages of 6 months up to 12 months, divided into two groups: a control group (n=34) without stimulation of erythropoiesis and the study group (n =36) using apre-stimulation oferythropoiesis darbepoetin alfa. RESULTS: In the control group, blood transfusion was performed in 79% of cases, compared with the test group-22% of cases. Also, the patients ofthe study group determined a statistically significant (p<0. 05) increase the level of red blood cells, hemoglobin and reticulocytes. CONCLUSION: In children up to a year with various forms ofnon-syndromic craniosynostosis preoperative stimulation of erythropoiesis in conjunction with normovolemic hemodilution reduces the number of blood transfusions 3 times, or to opt out of its holding.

[Biportal endoscopic removal of choroid papilloma of the lateral ventricle in a child].

The article is devoted to the use of minimally invasive techniques for removing intraventricular tumors; this topic is currently relevant to pediatric neurosurgery. As an example, a clinical case of complete removal of a choroid plexus papilloma in a child using the neuroendoscopic technique through the biportal approach is provided. This tumor is most commonly found in pediatric practice. Taking this into account, the use of minimally invasive surgical methods for treating this pathology is very important. The published data relating to this pathology, as well as to the use of neuroendoscopy for this disease, are fragmentary today. Therefore, one of the objectives of this work was to analyze the literature regarding etiopathogenesis, clinical presentation, diagnostic features, and some aspects of surgical treatment of choroid plexus papilloma, in connection with which this work is primarily of practical interest.

Effect of cyclopentyladenosine on lipid peroxidation during focal cerebral ischemia.

The antioxidant effect of an adenosine A1 receptor agonist cyclopentyladenosine was studied on the model of focal cerebral ischemia. Ischemic injury of the brain was accompanied by changes in LPO processes (in the blood and brain tissue) and failure of some factors for antioxidant protection (peroxidase and catalase) that inactivate reactive metabolites. Changes in the ratio between LPO and antioxidant protection were less pronounced after treatment with cyclopentyladenosine.

[Anticonvulsant and neuroprotective effects of cyclopentyladenosine on the model of convulsive status in rats].

The neuroprotective and anticonvulsant effects of cyclopentyladenosine (CPA) have been studied on a new experimental model of the convulsive status in rats aged 3-4 months and 10 days. The convulsive status was modeled by intracerebroventricular injection of ferakril (water-soluble polymer of polyacrylic acid) solution. It is established that prophylactic administration of CPA results in a relatively lower degree of neurological deficit, both in the acute phase and on the next day, compared to the untreated control. Considering that adenosine receptor agonists are analogs of the natural metabolites that have minimal side effects and expressed neuroprotective properties, the use of agents of this group is perspective for both prevention and treatment of seizure conditions in neurology and neurosurgery.

[Effect of cyclopentyladenosine on the orientation, exploratory, and emotional behavior of rats with model brain injury].

Effects of a local compression brain injury and the preventive application of cyclopentyladenosine (CPA) on the behavior of rats in the open field test was investigated. It is established that the local injury of a parietal cortex causes intensification of the orientation--research behavior and an increase in the emotional stress in rats. A protective action of CPA was manifested by a decrease in the expressiveness and duration of disturbances in the emotional and orientation--research behavior of animals in the open field test.

[Efficiency of neuroendoscopic operations in achieving shunt independency in hydrocephalus with liquor-shunting system dysfunction].

OBJECTIVE: to evaluate the efficiency of endoscopic treatments in achieving shunt independency in patients with hydrocephalus and shunt dysfunction. SUBJECTS AND METHODS: endoscopic treatment was performed in 28 patients (15 males and 13 females) aged 7.0 +/- 1.2 years (0.5-24 years) with hydrocephalus and CSF shunt dysfunction. The interval between the first shunt implantation and endoscopic surgery (the time of shunt dependency) was 43.4 +/- 7.8 months (5-180 months). All operations were made using the universal Gaab neuroendoscopic system (Karl Storz GmbH and Co., Germany). The follow-up lasted 49.4 +/- 6.9 months (6-120 months). RESULTS: All the patients were successfully operated on, without intraoperative complications and deaths being observed. Surgical interventions were as follows: endoscopic ventriculocisternostomy (n=23), endoscopic aqueductoplasty (n=1), and endoscopic cystoventriculocistemrnostomy (n=4). In 24 of the 28 patients, the symptoms of intracranial hypertension regressed completely. CSF shunt reimplantation was required in 3 cases and prolonged external drainage in 1 case of existing ventriculitis. It should be noted that 24 of the 28 patients became shunt-independent; a shunt was removed in 13.

Neuroendoscopic procedures in achievement of shunt independence: outcome analysis of 28 patients with shunt malfunction.

OBJECTIVE: The authors review their experience of the TV-controlled endoscopic technique in the treatment of shunt malfunction in 28 patients suffering from hydrocephalus. MATERIAL AND METHODS: We treated 28 patients (6.6+/-1.2 years) with shunt malfunctions by a neuroendoscopic procedure. The number of reimplantations of the shunt systems prior to the neuroendoscopic procedure varied from 1 to 13. Duration of the shunt dependency has averaged to 42.7+/-8.1 months (range: 5-180 months). All procedures were performed with the Gaab I neuroendoscope and Gaab II miniature neuroendoscope. All patients presented with neurological signs and deficits. The follow-up period has averaged to 32.3+/-6.2 months (4-114 months). CONCLUSION: Endoscopic surgery offers an effective technique in the surgical treatment of shunt malfunction. On the basis of our experience, the use of a neuroendoscopic procedure for shunt malfunction allows us to achieve shunt independence in 82.1% and shunt removal in 50.0%. The introduction of these methods is recommended in neurosurgical centers that are traditionally widely engaged in the treatment of hydrocephalus.

[Protective effect of A-agonists in a minimum invasive model of spinal cord ischemia in rats]. / Zashchitnoe deistvie A-agonistov na maloinvazivnoi modeli ishemii spinnigo mozga u krys.

The neuroprotective properties of N6-cyclohexyladenosine (CHA) and N6-cyclopentyladenosine (CPA), adenosine receptor agonists (A-agonists), were studied on a model of spinal cord ischemia (SCI) in rats (most closely reproducing the analogous clinical pathological process in humans). The SCI model was induced by intravasal occlusion of the abdominal aorta and its branches. CHA and CPA were introduced by intracerebroventricular injections in a dose of 25 micrograms/kg, 60 min before SCI induction. The protective effect was judged by comparing the patterns of neurological and histopathological disturbances in the untreated control (ischemia) and on the CHA or CPA background. The A-agonist CPA produced a pronounced, statistically reliable neuroprotector effect on the minimum invasive SCI model studied. CHA is also a statistically reliable but less effective neuroprotector. The A-agonists may have good prospects in clinics.

Changes in the steady-state potential in rats with focal cerebral ischemia receiving cyclopentyladenosine.

Brain function and neuroprotective activity of cyclopentyladenosine in rats with focal cerebral ischemia were evaluated by recording the steady-state potential. Cerebral ischemia was modeled by intravasal occlusion of the left internal carotid and middle cerebral arteries and bilateral occlusion of the common carotid arteries. Recording of the steady-state brain potential during experimental ischemia allowed identifying the development of ischemic depolarization by a negative potential shift. Changes in the steady-state potential after cyclopentyladenosine administration reflected delayed development of ischemic depolarization in the nervous tissue. Cyclopentyladenosine holds much promise for the protection of nerve cells from ischemic injury.

[Protective effect of cyclopentyladenosine in a minimally invasive model of acute cerebral focal ischemia in rats]. / Zashchitnoe deistvie tsiklopentiladenozina na maloinvazivnoi modeli ostroi fokal'noi ishemii golovnogo mozga u krys.

The neuroprotector properties of cyclopentyladenosine (CPA), an adenosine receptor agonist, were studied on a model of focal brain ischemia in rats (reproducing a clinical pathological process in humans). The model of the focal brain ischemia in rats was induced by intravasal occlusion of left carotid artery, middle cerebral artery, and by bilateral occlusion of both carotid arteries. CPA was introduced by intracerebroventricular injections in a dose of 25 micrograms/kg, 60 min before ischemia induction. The protective effect was judged by comparing the neurological and histopathological disturbances in the control (untreated ischemia) and on the CPA background. CPA injections produced a pronounced neuroprotector effect on the minimum-invasive focal brain ischemia model in rats.

[Protective effect of adenosine receptor agonists in a model of spinal cord injury in rats]. / Zashchitnoe deistvie agonistov adenozinovykh retseptorov na modeli travmaticheskogo povrezhdeniia spinnogo mozga u krys.

Possibilities of the neuroprotector therapy using adenosine and cyclopentyladenosine (CPA), an adenosine receptor agonist, were studied on a model of spinal cord injury by compression in rats (most closely reproducing the analogous clinical pathological process in humans). The model was induced by slow, graded compression of the spinal cord at the thoracic level. Adenosine and CPA were introduced 60 min before injury by subcutaneous injections in a dose of 300 and 2.5 micrograms/kg, respectively. The protective effect was judged by comparing the neurological, electromyographic, and histopathological changes in animals with the model injury and in the control group (adenosine and CPA background). The A1-agonist CPA injections produced a pronounced, statistically significant neuroprotector effect on the given spinal cord injury model in rats. The neuroprotective effect of adenosine was significant but not as strong. It is concluded that it is expedient to use A-agonists in clinics.

[The endoscopic diagnosis and differential treatment of the complications of shunting operations in children]. / Endoskopicheskaia diagnostika i differentsirovannoe lechenie oslozhnenii shuntiruiushchikh operatsii u detei.

The authors present their experience with endoscopic diagnosis and differential treatment of children with complications after bypass surgery. They show the present-day potentialities, spectrum of surgical interventions and role of video-assisted neuroendoscopic surgery in determining a treatment policy and choosing its method. A principle of multiportality was defined and substantiated, a diagnosis and treatment algorithm for children with this pathology was proposed by using the new minimum invasive technique video-assisted surgery.

[Endoscopic interventions in tumors of the pineal area, posterior regions of the III ventricle, and the posterior cranial fossa]. / Endoskopicheskie vmeshatel'stva pri opukholiakh zadnei pineal'noi iamki, zadnikh otdelov III zheludochka i zadnei cherepnoi iamki.

The study was undertaken to develop and introduce low-invasive differential endoneurosurgical correction of spinal fluid circulatory disorders in tumors of the pineal area, posterior portions of the third ventricle and the posteranial fossa. The authors present their experience in surgically treating 12 patients by using endoscopy. Surgical techniques, endoscopic semiotics of tumors of the above site, metastases along the liquor pathways are described. The outcomes of this treatment are analyzed. An algorithm of surgical treatment is proposed. Certain advantages of endoscopic interventions over conventional treatments in the treatment of tumor-induced occlusive hydrocephalus justify their inclusion into a comprehensive examination and treatment of patients of this study group.

[Neurosonography in the diagnosis of brain tumors in young children]. / Neirosonografiia v diagnostike opukholei golovnogo mozga u detei rannego vozrasta.

The possibilities of neurosonography (NSG) application in the diagnosis of tumors of the brain were studied in 16 children of the age from 1 month to 2 years. Standard NSG age indices for principal anatomic brain compartments as well as both direct and indirect diagnostic signs of tumors are presented. It is shown that NSG is a method of choice in screening of children of early age for brain tumor. This permits both to find it on an early stage, before the development of the pronounced cerebral and dislocation syndromes, and to make a grounded choice of surgical policy.

[Shunting operations in the hypertensive hydrocephalic syndrome in children with developmental defects of the central nervous system]. / Shuntiruiushchie operatsii pri gipertenzionno-gidrotsefal'nom sindrome u detei s porokami razvitiia tsentral'noi nervnoi sistemy.

By analyzing the outcomes of surgical treatment of 105 children with hypertensive syndrome of various genesis, the authors present their data on the detection, diagnosis, and treatment of children with malformations of the central nervous system (CNS). The paper defines the present feasibilities of neurosonography, magnetic resonance imaging, neuroendoscopic verification of CNS malformations and their place in determining the policy and choice of a surgical treatment. The rationale for and the efficiency of cerebrospinal fluid corrective operations in children with these abnormalities are defined. Less good prognosis and a higher risk of surgery for hydrocephalic complications have been revealed and statistically evidenced.