[Cerebrospinal fluid shunt malfunction not associated with ventricular enlargement. A case report and literature review]. / Disfunktsiya shunta tserebrospinal'noi zhidkosti bez rasshireniya zheludochkov mozga. Sluchai iz praktiki i obzor literatury.

Substantiation of the shunt failure diagnosis and subsequent consideration of indications for surgical elimination of the malfunction is a laborious and challenging process. Identification of a malfunction in doubtful cases requires, in addition to standard examinations, extra diagnostic procedures, which may delay making a decision for several weeks to several months. The article describes a case of mechanical CSF shunt malfunction (breakage and failure of a peritoneal catheter in a 7-year-old girl) with intracranial hypertension symptoms, but without typical enlargement of the brain ventricles. According to the medical history, congenital hydrocephalus in the child was accompanied by an inflammatory process of bacterial and viral etiology. The absence of brain ventricle enlargement was shown not to exclude a probability of shunt malfunction. In this case, a specific phenomenon, an intraparenchymatous cerebrospinal fluid "lake" surrounding a ventricular catheter, was observed. Shunting recovery did not lead to a significant reduction in the phenomenon size. Causes underlying this phenomenon require further investigation.

[Principles and experience of surgical treatment of spina bifida in adults].

AIM: The study objective was to summarize our own experience of surgical treatment of spina bifida in adults. MATERIAL AND METHODS: The mean age of patients was 33 years. The time elapsed since the onset of clinical presentations till surgery varied from 11 to 14 years. Among all elective, surgically significant pathologies of the spinal cord (tumors, syringomyelia, arachnoid cysts, spontaneous epidural hematoma, epidural abscess, abscess), spina bifida in adults amounted to 5.9%. RESULTS: The level of social adaptation of patients at the time of diagnosis was quite acceptable (patients had a normal index of intellectual development and the ability to move). The amount of surgery was large and included implementation of several important surgical manipulations. The operative time was 5.5 h, on average. As a result, the spinal cord and its roots were released from compression and retaining structures that, to some extent, allowed for avoiding dissection of the terminal ligament. CONCLUSION: Minimally invasive technologies can not still ensure implementation of all surgical manipulations for correction of the vertebral-medullary anomaly. Surgical treatment of congenital anomalies of the spinal cord in adults proved to be reasonable and effective.

[Lateral ventricle diverticulum as a variant of hydrocephalus evolution].

A clinical case of a 12 year-old girl with hydrocephalus complicated by rare condition, lateral ventricular diverticulum, is reported. Progression of the diverticulum was followed up according to MRI. The diverticulum of the lateral ventricular wall has emerged in the interval of 1 year (14 months have passed between the two MRI examinations) and spread towards the quadrigeminal cistern. In addition, compression of cerebellum, aqueductus cerebri Sylvii, and the fourth ventricle of the brain have emerged. A surgical treatment was suggested after the hydrocephalus had been initially revealed (when the diverticulum had not been formed yet); however, the child's parents refused the therapy. One year later, a series of epileptic seizures emerged, and MR scans showed a cystic neoplasm in the postcranial fossa above the cerebellum. The genesis of the cyst and its nature were unclear and additional invasive examination methods were required. MSCT ventriculography confirmed the diverticulum of the right lateral ventricle towards the quadrigeminal cistern.

[Case report of a "probable" cerebral amyloid angiopathy].

Sixty-two year old man was admitted to the department of neurosurgery after stroke episode. CT-scan revealed non-traumatic, non-hypertensive intracerebral hemorrhage in the left temporal lobe; cerebral amyloid angiopathy was suspected. Initially, according to Boston criteria, intracerebral hematoma was interpreted as a result of a "probable" cerebral amyloid angiopathy. Surgical evacuation of the hematoma lead to the partial recourse of speech and cognitive deficit. Four weeks after stroke onset and 3 weeks after surgery CT was performed, which revealed intracerebral hematoma in the right parietal lobe; this fact let to diagnose "probable" cerebral amyloid angiopathy. The second hematoma was evacuated, and surgical treatment together with medical therapy improved patient's quality of life. Treatment strategy for the intracerebral hematomas resulting from cerebral amyloid angiopathy has not been justified yet, which requires further investigations.

[Atypical reconstruction of shunt in treatment of hydrocephalus combined with isolated intracranial arachnoid cysts (transtentorial and sylvian fissure)].

The paper describes a case of treatment of 4-year old male patient with rare combination of 2 intracranial arachnoid cysts with hydrocephalus. First surgery (VP-shunt) was performed in the age of 10 months. 3 years later decompensation resulted in seizures. Detailed non-invasive visualization of intracranial CSF compartments was achieved by multispiral CT scans. Selection of surgical treatment was complicated. Reoperation and atypical shunting resulted in balanced relationships of intracranial volumes and steady clinical improvement.

[The role of biochemical processes in the pathogenesis of complicated hydrocephalus in children]. / O roli biokhimicheskikh protsessov v patogeneze oslozhnennoi vodianki golovnogo mozga u detei.

Spinal fluid radical formation levels, malonic dialdehyde concentrations, and intrinsic antioxidative activity were studied in 84 patients with hydrocephalus. The findings suggest that there is a considerable activation of free radical reactions and lipid peroxidation, as well as a reduction in antioxidative activity. These changes were most drastically profound in children with inflammation-complicated hydrocephalus with spinal fluid hemorrhagic changes in particular. Timely correction of impaired energy exchange in children by using antioxidants and nootropics promotes the arrest of inflammation and prevents a number of postoperative complications.

[Study of free radical oxidation of lipids in cerebrospinal fluid of hydrocephalic children]. / Issledovanie protsessov svobodnoradikal'nogo okisleniia lipidov v likvore detei s gidrotsevaliei.

The levels of free radical production, malondialdehyde concentration and antioxidant activity were estimated in ventricular liquor of the infants with primary hydrocephalus. It was shown that even in the case of uncomplicated hydrocephalus significant disorders in brain metabolism took place. In the patients with inflammatory or hemorrhagic complications the levels of malondialdehyde and free radicals were markedly increased as compared to the infants with "pure" hydrocephalus. The most significant disorders were revealed in the case of hemorrhagic complications. These data indicate the necessity of lipid peroxidation evaluation in liquor of the patients with hydrocephalus and help to workout indications for antioxidants including into the common therapy of this decrease.