[Application of expanders in surgical treatment of an infant with large myelomeningoradiculocele].

In the article authors describe application of expanders for effective closure of skin defect after surgical removal of large myelomeningoradiculocele in an infant.

[The topographic anatomical basis for ventriculosinusal shunting in hydrocephalus in nursing and young infants]. / Topografoanatomicheskoe obosnovanie ventrikulo-sinusnogo shuntirovaniia pri gidrotsefalii u detei grudnogo i rannego vozrasta,

The peculiarities in the structure and topographic anatomical relations of the superior longitudinal, lateral, and sigmoid sinuses were studied on block preparations of the posterior cranial fossa of 14 children under 3 years of age who died from somatic diseases. It was shown that intrasinus inclusions preventing catheterization of the sinus (bands and septa) were absent at the junction of the first angle of the sigmoid sinus with its descending part. The authors recommend this area for shunting operation--ventriculosinusotomy--in progressive hydrocephalus.

[Surgical treatment of suprasellar cerebrospinal fluid cysts]. / Khirurgicheskoe lechenie supraselliarnykh likvornykh kist.

The authors discuss 18 child patients with suprasellar cysts containing cerebrospinal fluid; 16 of them were operated on. The following types of interventions were performed: ventriculocisternostomy, ventriculoatriostomy, excision of the cystic walls through a transventricular-transcortical, combined subfrontal and transcallosal, and only a subfrontal approaches; shunting operations--cystoatriostomy and cystoperitoneostomy. Excision of the walls of the cyst is preferable.

[Shunt surgery in occlusive processes in the posterior cranial fossa of children]. / Shuntiruiushchie operatsii pri okkliuziruiushchikh protsessakh v zadnei cherepnoi iamke u detei.

Shunting of the cerebrospinal fluid by drainage systems of various design was conducted in 64 children aged from 4 months to 14 years with occlusive processes in the posterior cranial fossa. The occlusion was caused by a tumor in 57 cases and by an arachnoid cyst in 7 cases. All children were related to the high risk group, i. e. the prognosis of direct manipulation on the posterior cranial fossa was poor or doubtful. In 26 children surgery was limited to a shunting operation without subsequent intervention on the posterior cranial fossa. The successful implantation of the drainage system was recorded in 45 children (70.2%). In infants and young children as well as in older ones with sharply manifested hypertensive and secondary stem symptomatology the outcome was much better when the shunting operation was conducted before or at the same time as the intervention on the posterior cranial fossa. The prognosis is poorer in infants and adolescents and in primary tumors of the brain stem.

[Elastic properties of the cerebrospinal system and cerebrospinal fluid dynamics in intracranial hypertension and normotensive hydrocephalus in adults]. / Elasticheskie svoistva tserebrospinal'noi sistemy i likvorodinamika pri vnutricherepnoi gipertenzii i normotenzivnoi gidrotsefalii u vzroslykh.

Time course of changes of the CSF and the elastic properties of the cerebrospinal system were studied in 25 patients with normotensive hydrocephalus and in 26 patients suffering from benign intracranial hypertension. In 66% of cases with the normotensive hydrocephalus syndrome and in 60% of those with benign intracranial hypertension CSF resorption resistance and the elasticity gradient increased. Shunting operations proved effective in such cases.

[Valveless shunting in occlusive hydrocephalus in children]. / Besklapannoe shuntirovanie pri okkliuzionnoi gidrotsefalii u detei.

Operations were carried out on 32 children for the occlusive form of hydrocephalus with impaired resorption of the cerebrospinal fluid. Thirty children were under the age of 12 months, two were up to 2 years of age. Twenty-seven patients underwent two interventions either in one stage or at an interval of up to 4 months: ventriculocisternostomy (VC) and lumboperitoneal anastomosis by means of an avalvular shunt; five children were subjected only to VC. Hydrocephalus was stabilized in 18 children (85.7%) by the combined intervention and in 1 (20%) by means of VC alone. One-stage performance of Torkildsen's operation with lumboperitoneal anastomosis produces results, which are more reliable and fewer complications. These two operations can be conducted separately at some interval only if the child is very weak in the preoperative period and vital disorders occur during the surgical intervention. The performance of VC without subsequent lumboperitoneal anastomosis is a great risk for infants and young children. The developed techniques of one-stage VC with lumboperitoneal anastomosis and the use of avalvular drains is simple and reliable, which allows it to be recommended for wide use in neurosurgical practice.

[Radionuclide cisternography in the diagnosis of pathology of the cerebrospinal fluid system in children]. / Radionuklidnaia tsisternografiia v diagnostike patologii likvornoi sistemy u detei.

Radionuclide cisternography (RCG) was performed in 78 children with different forms of hydrocephalus: external, internal (ventricular) and obstructive. Radiological signs were determined by spatial-time distribution of a radiopharmaceutical over the liquor pathways. Morphological and liquorodynamic disorders (liquor circulation and resorption disorders) served as a basis for the differentiation of hydrocephalus forms.

[Ultrasonic method of studying intracranial blood and cerebrospinal fluid dynamics in healthy subjects and in pathology]. / Ul'trazvukovoi metod issledovaniia vnutricherepnoi gemolikvorodinamiki v norme i patologii.

A noninvasive ultrasonic method of brain biolocation with the sensor positioned in the region of the frontal eminences, was developed. The selected signal from an immobile structure, the occipital bone, is registered graphically. The method allows the cerebral hemispheres to be studied separately, yields information which is more precise than that obtained by means of the commonly known methodical approaches, and provides data on the intracranial dynamics of blood and cerebrospinal fluid. The results of the study provide evidence of a statistically significant (P less than 0.05) shift in the index of ultrasonics pulsed fading (alpha p) in healthy individuals and in patients with cerebral lesions and changes in the functional and neurological state. To verify the noninvasive methods parallel studies were conducted by means of the invasive method.

[Selection of a method of treating the hydrocephalic syndrome in children]. / Vybor metoda lecheniia gidrotsefal'nogo sindroma u detei.

Differentiated therapy in relation to the stage and form of hydrocephalus was elaborated on the basis of observations of 128 children with the overt form of progressive hydrocephalus treated conservatively and 111 children with overt and covert forms who had undergone surgery of bypassing the cerebrospinal fluid spaces. In cases of the acute growth of the intracranial hypertension, diuretics are used, and the pressure in the cerebrospinal system is alleviated by puncture of the lateral ventricle and removal of the fluid. In the chronic course of the disease with slow enlargement of the head size, it is indicated to use diacarb (acetazolamide) which is a carboanhydrase inhibitor and decreases the production of the cerebrospinal fluid. In obstructive hydrocephalus and failure of conservative therapy of its overt form, the only method of treatment is surgical intervention aimed at draining the cerebrospinal fluid from the cerebrospinal fluid spaces into the right atrium or the peritoneal cavity with the help of implanted shunts. The combination of conservative and surgical methods of hydrocephalus treatment makes it possible to achieve good results in the overwhelming majority of cases.

[Disorders of higher mental functions in the early stages of hydrocephalus]. / O narusheniiakh vysshikh psikhicheskikh funktsiei u bol'nykh s rannei gidrotsefaliei.

The authors have carried out neuropsychological examinations of 32 children operated for hydrocephalus on the first year of the life. A syndrome of the higher psychic function disturbances characteristics for children with early hydrocephalus is described, and the results of the neuropsychological function examinations were compared with the character, etiology, and gravity of the hydrocephalus. In the children with the early hydrocephalus a high incidence of sinistrality was revealed, the fact, that gives one grounds to explain the peculiarities of the syndrome observed in them by an anomaly of the development of the brain functional asymmetry.

[X-ray diagnosis of hydrocephalus in infants and young children]. / Rentgenodiagnostika gidrotsefalii u detei grudnogo i rannego vozrasta.

The article shows the results of X-ray examination of 49 children (including 41 neonates) in 43 of whom 54 various radiocontrast studies were conducted for exact preoperative identification of the form of hydrocephalus (whether closed or open). Modified pneumoencephalography without removal of fluid is suggested for infants, which yields an important diagnostic information necessary for choosing the methods of surgical treatment of hydrocephalus in children of early age and neonates.

[Local use of levomycetin in neurosurgery]. / Mestnoe primenenie levomitsetina v neirokhirurgii.

A method of local application of the unsoluble medicinal form of chloramphenicol during operations has been developed. Administration of the preparation in a dose up to 2g under an osteal or cutaneous graft induces no side complications and forms a depot of the agent therapeutic concentrations for more than 8 days. There exists a direct relationship between the increasing of staphylococcus resistance to chloramphenicol and the quantity of the agent used in patients.

[Clinico-physiologic analysis of the effect of decompressing the cerebrospinal fluid system in children with hydrocephalus]. / Kliniko-fiziologicheskii analiz vliianiia rezgruzki likvornoi sistemy pri gidrotsefalii u detei

Changes in vascular tonicity and blood filling in the brain were studied in 26 children with occlusive hydrocephalus during ventricular punctures and following surgical elimination of the occlusion. The nature of the reactive changes in the tonicity and blood filling of the cerebral and peripheral vessels was found to be different in response to the draining of the CSF system depending on the level of thebrain lesion. Following ventricular punctures with CSF draining the majority of the examined demonstrated a normalization of their elevated tonicity of the cerebral vessels and a disappearance of hampered venous drainage. The dynamics of the vascular responses developing under the effect of dehydration agents is characterized by the maximum response 30-50 min following the administration of the drug and by a gradual restoration of the initial state some 2-2 1/2 hours later.