[Treatment of neuropathy of inferior gluteal and pudendal nerves following periarticular synovial cyst of the hip joint. A case report and literature review]. / Rezul'tat lecheniya nevropatii nizhnego yagodichnogo i polovogo nervov, vyzvannoi periartikulyarnoi sinovial'noi kistoi tazobedrennogo sustava. Sluchai iz praktiki i obzor literatury.

The authors report a patient with neuropathy of inferior gluteal and pudendal nerves following periarticular synovial cyst of the hip joint. Effectiveness of treatment was analyzed. ENMG and MRI of pelvic soft tissues and hip joint were applied to confirm neuropathy of inferior gluteal and genital nerves. Periarticular synovial cyst of the hip joint followed by compression and ischemia of inferior gluteal and pudendal nerves was detected. In pre- and postoperative period, intensity of pain syndrome was assessed using visual-analogue scale. Neuropathic pain and quality of life were evaluated using the Leeds scale (LANSS) and NeuroQoL questionnaire, respectively. The patient underwent microsurgical neurolysis and decompression of inferior gluteal and pudendal nerves and resection of periarticular synovial cyst of the hip joint. Complete regression of pain syndrome and improvement in quality of life were observed after surgery. Compression of neurovascular structures with periarticular hip cysts followed by clinical and neurological disorders is an indication for microsurgical neurolysis and resection of cyst.

Individual Navigation Templates for Subcortical Screw Placement in Lumbar Spine.

Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation. The aim of the study was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy. Materials and Methods: The study was based on the analysis of treatment results in 39 patients who underwent surgery with subcortical implantation of 130 screws using the MidLIF technique. In group 1, navigation templates were used, in group 2 - intraoperative fluoroscopic control. Comparative analysis of implantation correctness and time, the total operation time, and radiation load was performed. Results: The mean distance between the screw and the cortical plate recorded in the groups ranged within 1.20-3.97 mm, without statistically significant difference (p>0.05). The mean time of pedicle screw implantation was 137.0 [115.25; 161.50] s in group 1 and 314.0 [183.50; 403.25] s in group 2. The total operation time was reduced from 173.0 [155.0; 192.25] min in group 2 to 119.0 [108.0; 128.75] min in group 1. The average of 1.0 [1.0; 2.0] X-ray image was performed to place one screw in group 1, while it was 12.0 [10.0; 13.25] in group 2. The differences between the groups in terms of implantation time and radiation load were statistically significant (p<0.05). Conclusion: Compared with intraoperative fluoroscopy, the use of individual navigation templates for subcortical implantation of pedicle screws provides their correct positioning with a significant reduction in both operation time and radiation load at similar safety.

[Assessment of the safety and accuracy of implantation of screws into the C2 vertebra using individual 3D-navigation matrices]. / Otsenka bezopasnosti i tochnosti implantatsii vintov v S2 pozvonok s primeneniem individual'nykh 3D-navigatsionnykh matrits.

INTRODUCTION: Individual 3D-navigation matrices are valuable to increase the safety of screw implantation into the axis. OBJECTIVE: To analyze safety and accuracy of screw deployment into the axis using individual 3D-navigation matrices compared to free hand technique. MATERIAL AND METHODS: A retrospective analysis included 23 patients (group 1) who underwent implantation of 44 screws into the axis using the «free hand¼ technique. The screws were installed along the transpedicular or pars trajectory. A prospective analysis enrolled 17 patients (group 2) who underwent installation of 34 screws using individual navigation matrices. 3D-printing technology was applied for manufacturing these matrices. Implantation results were evaluated considering postoperative CT data and SGT (Screw Guide Template) system. RESULTS: In the 1st group («free hand¼), grade 0 and 1 (no malposition or less than 50% of screw diameter) were recorded for 29 (65.91%) screws, grade 2 - for 13 (29.55%) screws, grade 3 - for 2 (4.45%) screws. Intraoperative injury of the vertebral artery without postoperative neurological deficit occurred in 4 (8.89%) patients. In the 2nd group, 97% of screws were implanted in accordance with grades 1 and 2. Deviation grade 2 was registered in 11 cases (32.35%). Mean deviation was 1.8 ± 1.0 mm. In the 2nd group, 28 (82.35%) out of 34 screws were completely within the bone structures (grade 0), 4 (11.76%) screws perforated pedicles for less than 50% of their diameter (grade 1). There were 2 cases of malposition grade 2 and 3 without vertebral artery injury. CONCLUSION: Individual 3D navigation matrix is an effective method for screw installation into the axis. This approach exceeds fluoroscopy-assisted "free hand" technique in terms of safety of implantation.

[The intraoperative prophylaxis of local ischemical brain damage in neurosurgical patients with cerebral aneurysm]. / Intraoperatsionnaia profilaktika lokal'nogo ishemicheskogo povrezhdeniia golovnogo mozga u neirokhirurgicheskikh patsientov s tserebral'noi anevrizmoi.

AIM: To study the effectiveness of intraoperative administration of Cytoflavine for the prevention of ischemic brain injury during cerebral aneurysm (CA) clipping with temporary occlusion of the leading artery under general anesthesia. MATERIAL AND METHODS: The prospective cohort single-center study included 40 patients with CA ( the main group - 27 patients with intraoperative administration of cytoflavine; the comparison group -13 patients without use of cytoflavine), who underwent aneurism clipping with temporary occlusion of the afferent artery. We assesed the intraoperative state of the brain, the time of awakening and extubation of patients after surgery, neurological deficit and local ischemic changes in the area of surgery according to the CT of the brain in the early postoperative period, resuscitation bed-day and the relationship of these indicators with the duration of temporary occlusion of the afferent artery in the selected groups of patients. RESULTS: In intergroup comparison, patients of the main group treated with intraoperative cytoflavin showed a reduction in the time of awakening (p=0.013) and the time of extubation (p=0.01) both with temporary occlusion of the afferent artery and in patients without temporary occlusion (p<0.05). The duration of resuscitation bed-day decreased in the main group of patients receiving intraoperatively cytoflavine (p=0.01), as well as in patients in the comparison group without temporary occlusion (p<0.05). CONCLUSION: Temporary occlusion of the afferent artery with short intervals of vessel occlusion in combination with intraoperative intravenous administration of cytoflavine expands the tolerability to artery occlusion in patients operated in the 'cold' period, reduces the possibility of neurological deficit, reduces the recovery period and resuscitation bed-day after surgical clipping CA.

[Quality of life in patients with pituitary adenomas in the pre- and postoperative period]. / Issledovanie kachestva zhizni bol'nykh s adenomami gipofiza v do- i posleoperatsionnom periodakh.

OBJECTIVE: To evaluate changes in quality of life in patients before and after the resection of pituitary adenoma. MATERIAL AND METHODS: A clinical study involved 42 patients with pituitary adenomas. The diagnosis was based on clinical laboratory data, findings of radiology imaging and instrumented tests. Pituitary adenomas were resected through the transsphenoidal approach. Patients' quality of life was analyzed in the preoperative and early postoperative periods. Patients were aged 22-63 years (median age, 45 years). A specialized EORTC QLQ-C30 questionnaire developed by the Quality of Life Group of the European Organization for the Research and Treatment of Cancer was selected for evaluation of quality of life in the pre- and postoperative periods. This questionnaire has been used in many international clinical studies. RESULTS: The patients showed positive dynamics during the postoperative period according to all functional scales. Such symptoms as fatigue, pain intensity, frequency of nausea, vomiting and shortness of breath were reduced in patients after the surgery. Intestinal motility was postoperatively normalized in these patients (the frequency of diarrhea or constipation events was reduced). The sleeping pattern was normalized. The patients also noted that their expected financial difficulties became less pressing after the surgery. The score corresponding to patients' overall wellbeing was improved. Progression of such symptom as the loss of appetite was observed in patients after the surgery. CONCLUSION: Pre- and postoperative evaluation of various quality of life parameters in patients with pituitary adenomas revealed that gross total resection of pituitary adenoma through the transsphenoidal approach improved patients' quality of life.

[Evaluation of transsphenoidal adenomectomy outcomes in acromegaly using different remission criteria]. / Otsenka rezul'tatov transsfenoidal'noi adenoméktomii pri akromegalii s primeneniem razlichnykh kriteriev remissii.

For a long time, surgical removal of somatotropinoma using the transsphenoidal approach has been the first stage of treatment in most acromegaly patients. For the past decades, the efficacy criteria for surgical treatment of acromegaly have significantly changed, which requires appropriate correction. PURPOSE: We aimed to evaluate the results of transsphenoidal adenomectomy in acromegaly patients using various criteria for disease remission. MATERIAL AND METHODS: The study included patients with newly diagnosed acromegaly who underwent transnasal transsphenoidal endoscopic adenomectomy performed by a single neurosurgeon. The surgical treatment outcomes were evaluated 6 months after operative intervention based on levels of IGF-1, OGTT, and GH. The obtained data were analyzed using different threshold values for the level of GH nadir during OGTT: criteria A <2.0 ng/ml, criteria B <1.0 ng/ml, and criteria C <0.4 ng/ml to assess acromegaly remission, along with matching of the IGF-1 level to the reference range for a given gender and age. RESULTS: The study included 70 patients (52 females and 18 males) with a mean age of 52.2±11.5 years (29 to 73 years). The baseline IGF-1 level exceeded the upper limit of the reference range 3.3±1.4 (1.1-7.3)-fold, on average. The baseline mean basal GH level was 34.2±41.7 (1.2-192.0) ng/ml. The mean pituitary adenoma size was 16.7±8.6 (4.3-46.0) mm; 18 (26%) out of 70 patients had pituitary microadenoma, and 52 (74%) patients had macroadenoma. Six months after surgery, acromegaly remission met criteria A in 47 (67%) patients, criteria B in 28 (40%) patients, and criteria C in 18 (26%) patients. CONCLUSION: Our findings demonstrate that evaluation of transsphenoidal adenomectomy outcomes in treatment of acromegaly patients depends on the criteria chosen for assessing remission. This feature should be considered when comparing outcomes of surgical treatment for acromegaly in different years. Probably, introduction of the 2010 criteria should be accompanied by revision of the previous remission indicators.

[Assessment of life quality and job satisfaction of neurosurgeons in the Russian Federation (a sociological study)]. / Otsenka kachestva zhizni i professional'noi udovletvorennosti neirokhirurgov, rabotaiushchikh v RF (sotsiologicheskoe issledovanie).

PURPOSE: The study purpose was to investigate and evaluate factors of career satisfaction among neurosurgeons in the Russian Federation. MATERIAL AND METHODS: During the pilot study, 217 neurosurgeons in the Russian Federation were surveyed in 2016. The survey was conducted through an anonymous voluntary questionnaire. The questionnaire consisted of four sections: 1) demographic data; 2) evaluation of professional stress factors; 3) characteristics of job satisfaction; 4) quality of life indicators. Responses in ordinal scales were evaluated using one-dimensional frequency analysis; factors related to career satisfaction were assessed using correlation and regression analyses. RESULTS: More than 80% of the respondents were males under the age of 40, ordinary doctors, without a scientific degree, with less than 15 years of work experience, performing less than 150 operations a year, and receiving wages less than 60 thousand rubles per month. The most common negative job-related factors of occupational stress included a large amount of work with medical records and insufficient wages. Only 51% of neurosurgeons were in general satisfied with their career. The greatest dissatisfaction in more than 55% of respondents was associated with the lack of time for personal development. More than 83% of respondents considered their legal protection insufficient. A correlation analysis revealed the greatest correlation (about 0.4) between career satisfaction and opportunities for professional growth as well as between mutual understanding with colleagues and confidence in the future. In addition, a regression analysis revealed the following factors: time for doing science, confidence in a stable salary, work on weekends, knowledge of English, and insufficient supply of consumables. CONCLUSION: Career satisfaction of the neurosurgeon depends mainly on working conditions and confidence in career prospects.