Noninvasive assessment of the elastance and reserve capacity of the craniovertebral contents via flow velocity measurements in the straight sinus by TCD during body tilting test.

Invasive recording of intracranial pressure (ICP) changes during cerebrospinal fluid (CSF) infusion-drainage tests have been used to estimate elastance and reserve capacity of craniovertebral contents. The increase in ICP and its pulse-related oscillations lead to "cuff constriction" of cerebral veins. The purpose of this study is noninvasive assessment of elastance and reserve capacity of craniovertebral contents (RCCC) by measurement of flow velocity (FV) in the straight sinus by transcranial Doppler (TCD) during body tilt tests, which cause changes in ICP. The study was performed in 14 healthy volunteers (age 12-49 y, 6 men) and 32 patients with Intracranial Hypertension (IH) (Benign Intracranial Hypertension, n = 14; Brain Tumors, n = 18). The straight sinus was insonated through the occipital window during body tilt tests (BTT). Tilt table position was changed gradually from head up (+75 degrees) to head down (-45 degrees). It was established that systolic flow velocity and amplitude of FV pulsations (Amp) in horizontal position in patients is usually higher than in healthy volunteers. We found that reserve capacity of craniovertebral contents in patients with IH was usually exhausted. Elastance in patients was usually significantly higher than in healthy volunteers. Evaluation of cerebral venous circulation during body tilt tests clearly differs between the patients with IH and the healthy volunteers. The degree of this difference depends on the localization and character of the pathologic process.

[Quantitative assessment of the cerebrospinal fluid dynamic parameters in patients with the "benign" intracranial hypertension syndrome. 2]. / Kolichestvennaia otsenka parametrov u bol'nykh s sindromom "dobrokachestvennoi" vnutricherepnoi gipertenzii. Chast' 2.

The development of the benign intracranial hypertensive syndrome was shown to be followed by changes in liquorodynamic parameters and elastic properties of the brain. In 99% of patients, the baseline liquor pressure was elevated by 1.5-2.5 times as compared to normal values. Resistance of liquor resorption was enhanced in 82% of cases, suggesting impaired normal liquor outflow. The increased brain elasticity gradient suggests the exhaustion of cerebrospinal compensatory potentialities and correlates with the increased liquor resorption resistance. A correlation analysis of liquorodynamic parameters by taking into account clinical signs yielded a pathogenetic scheme of the development of the benign intracranial hypertensive syndrome.

[Use of a point-scale assessment of patient status in the surgical treatment of craniocerebral injuries]. / Ispol'zovanie ball'noi otsenki sostoianiia bol'nykh pri khirurgicheskom lechenii cherepno-mozgovoi travmy.

The indications and contraindications for surgical treatment in craniocerebral trauma (CCT) were based on estimation of the patient's condition in marks; the dynamics of changes of the results of the estimation in the pre- and postoperative periods were studied. A total of 375 patients with CCT were examined in different medical institutions according to a unified method. Neurosurgical interventions were carried out on 155 patients. All patients who underwent operation when their condition was rated below 15 marks died on the immediate postoperative days, whatever their age and whatever the time of the operation after the trauma. The probability of a favourable outcome increased to 40% in a condition rated 21-30 marks on the day of the operation and reached 69% when it was above 30 marks.