[Methodological aspects of surgical approach in victims with severe multiple craniofacial trauma in consideration of severity of traumatic injury].

It is important to improve the medical care system and treatment of victims, introduce new methods of treatment and attract the multidisciplinary specialists in the cases of multitrauma. An integrated approach is required for the identification of different character and severity of multiple craniofacial injuries and the development of rational surgical strategy on this base. Different scales such as AIS, CRIS, ISS, PTS, TRISS, TRISSCAN, CRAMS et.al, were created abroad. Another approach to medical strategy was developed in the department of military surgery of Kirov Military Academy in the late nineties. It was based on investigating of possibilities of surgical strategy optimization by application of objective evaluation of the severity of injuries (military surgery--SP, SG, SS). Given treatment strategy of victims with multiple craniofacial trauma resulted in double reduction of quantity of suppurative and septic complications (from 10.5% to 4.1%). It gave the possibility to reduce the lethality from 6.4% to 4.0%. At the same time a hospital stay was shortened and the strategy allowed obtaining satisfactory functional results of treatment and avoiding reinterventions for removal of posttraumatic facial deformations.

[Substantiation of the choice of treatment strategy in isolated traumatic injury of the frontal lobes of the brain].

An analysis of the results of the treatment of 132 patients with isolated traumatic parenchymatous injury of the frontal lobes of the brain was made. The treatment strategy was determined in consideration of the traumatic substratum volume and a combination of neurologic status and instrumental data. There were unfavorable risk factors to the course of traumatic parenchymatous injury of the frontal lobes of the brain such as low initial GCS score, the progression of neurologic deficiency in the presence of contusion hemorrhagic foci in the frontal lobe with the volume more than 25 cm3, shifting of midline structures on 5 mm and more or signs of deformation of basilar region cisterns and the presence of mass-effect according to the tomographic data. The developed algorithm allowed improving the results of treatment and the quality of life for patients with traumatic parenchymatous injury of the frontal lobes of the brain.

[Intraoperative photon therapy in combination with mapping of motoric cerebral cortex in surgery of metastatic tumours of functionally significant zones of the large hemispheres of the brain].

Intraoperative radiation photon therapy (IORT) is a current effective technique based on the radiation exposure of extirpated tumor bed. This method is used in neurosurgery as a part of combined treatment of intracranial malignancies. The article presents the technique, an analysis of surgical treatment of 10 patients with cerebral metastases form of the lung and breast cancer, located in functionally important zones of the brain or nearby. IORT was performed using Carl Zeiss Intrabeam PRS 500(tm) system in combination with preoperative image-guided transcranial motor cortex mapping carried on Nextim NBS. There weren't observed the intraoperative or postoperative complications.

[Differentiated treatment of isolated traumatic injury of frontal lobes of the brain].

An analysis of treatment results was made in 83 patients with traumatic parenchymatous injuries of frontal lobes of the brain. Surgical interventions were performed in 31 patients and the conservative therapy was carried out in 52 patients. Regular neurological examinations were completed for all the patients. The data of neurovisual methods were estimated. A strategy of treatment of frontal lobes injury depends on not only from the traumatic substratum volume, but at the same time, it is formed by clinical neurologic constellations and instrumental data in traumatic injury of frontal lobes of the brain. Risk factors of unfavorable effect of traumatic parenchymatous injury of frontal lobes of the brain were reflected in the initially low GCS score, a neurologic deficit progression with contusion haemorrhagic foci in the frontal lobe (volume greater than 25 cm3), a midline shift on 6 mm or more and signs of base cistern compression and presence of mass-effect, according to CT scan data. The developed algorithm could improve the results of treatment and makes better the quality of life of the patients with traumatic parenchymatous injuries of frontal lobes of the brain.

[Complex approach to assessment of condition severity in patients with pyoinflammatory odontogenous diseases].

Dynamics of mean value indices and mean dispersion doesn't exclude the feedback (Mayanskiy D.N., 2008) in process of study the disease according to cooperative processes using system leukocyte-monocyte-lymphocyte (L+M+LM). The authors investigated a dynamic balance between these cell substratums and collagen formation. Acute inflammatory processes in tissues of maxillofacial area accompanied by leukemoid response of peripheral blood in the form of leukocytosis (10 x 10(9)-15 x 10(9)/l and more). The authors completely agree with the opinion of M.M. Solov'yov (2012) and N.K. Artyushenko (2008) that mechanism of this reaction is associated with both the leukocyte redistribution in the inflammation zone and with changes of hematopoietic rostock which aimed to balance the affected compensatory mechanisms of nonspecific resistance.

[Video endoscopy in neurosurgery]. / Videoéndoskopiia v neirokhirurgii.

The authors present an analysis of their experiences with performing more than 330 video endoscopic operations on the autopsy material and in 172 patients. In 54 of these patients operations were performed for traumatic intracranial convex hematomas, in 21 for adenomas of the hypophysis, in 14--for arterial aneurysms, and 53 patients with discogenic radiculitis, spinal tumors, consequences of severe spinal traumas. In 25 patients the endoscopic videomonitoring was made during excision of the tumors, paratumorous cysts and abscesses of the brain, decompression of the optic nerve, plasty of the anterior cranial fossa fundus with closing the liquor fistulas. Intraoperative angioscopy in carotid endarterectomy was fulfilled in 5 patients. The video endoscopy was proved to result in less traumaticity of the radical surgery. It is a valuable and highly informative method giving optimum results in performing many microsurgical operations.

[The combined use of intraoperative video endoscopy and contact microvascular dopplerography in the surgery of cerebral aneurysms]. / Kompleksnoe ispol'zovanie intraoperatsionnoi videoéndoskopii i kontaktnoi mikrososudistoi dopplerografii v khirurgii anevrizm golovnogo mozga.

The article describes results of an anatomo-clinical investigation using video-endoscopy and contact microvascular dopplerography in surgery of cerebral aneurysms. The endoscopic anatomy of cisterns of the cerebral base was studied in 36 corpses of adult humans. More than 200 video-endoscopic operative interventions were performed on sectional material. Video-endoscopy in combination with contact microvascular dopplerography was conducted in the clinic on 20 patients with aneurysms of the brain. Main advantages of endoscopy used in combination with microvascular dopplerography during clipping the aneurysm are formulated. Complex using the two methods described gives less volume of the access and traumaticity of the intervention but not less radical effect. It is a valuable and highly informative method which optimizes performing the operation and has less amount of postoperative complications.