[Clinical and neurophysiologic aspects of surgical treatment of pharmacoresistant forms of epilepsy]. / Kliniko-neirofiziologicheskie aspekty khirurgicheskogo lecheniia farmakorezistentnoi épilepsii.

Surgical treatment of pharmacoresistant forms of epilepsy under neurophysiological monitoring is a key problem studied in A.L. Polenov Russian Neurosurgical Institute (Saint-Petersburg). A summary of long-term studies and main stages of surgical treatment development are presented. The indications and contra-indications, along with basic neurophysiologic strategic and tactic arguments of open and stereotaxic treatment of focal and generalized epilepsy based on neurophysiologic model which determines a role of epileptic focus, epileptic and inhibiting brain systems in spreading and arresting of seizure discharge at each disease stage are formulated. A program of clinico-neurophysiologic monitoring of temporal epilepsy in pre- and intraoperative periods is considered.

[The combined treatment of severe craniocerebral trauma taking into account the nature of the brain damages and the extent of the hypertensive-dislocation syndrome]. / Kompleksnoe lechenie tiazheloi cherepno-mozgovoi travmy s uchetom kharaktera povrezhdenii golovnogo mozga i vyrazhennosti gipertenzionno-dislokatsionnogo sindroma.

The intracranial pressure was measured in 95 patients with a severe cranio-cerebral trauma at the postoperative period. Four degrees of the hypertension-dislocation syndrome were established. The characteristic of operative accesses is given. Drainage of the ventricular system of the brain and anterior falxotomy were shown to be expedient. The estimation is given to the efficiency of dehydration therapy at the early postoperative period against the background of intracarotid and intravenous infusions of remedies.

[Changes in human cerebral cortex in various areas of concussion in severe cranio-cerebral injury]. / Izmeneniia kory bol'shogo mozga cheloveka v razlichnykh zonakh ochaga usiba s razmozzheniem pri tiazheloi cherepno-mozgovoi travme.

In 23 patients with a severe cranial-cerebral trauma the operative material (pieces of the cortex, obtained from the destructive, transitional and relatively preserved zones in the bruise foci with crushing, localized in various lobules of the cerebral hemispheres) has been studied. From 2 h up to 9 days after trauma, changes, characterizing the state of the vascular bed, nervous and glial cells have been followed. In the external area of the transitional zone in 15 patients and in the relatively preserved zone in all the patients reversibly altered nervous cells predominate. Only in the destructive zone in all 23 patients and in the whole transitional zone in 8 patients neurons in all cortical layers are deeply injured and unviable. Certain considerations on differential surgical tactics, when treating the bruise foci with crushing at a severe cranial and cerebral trauma are presented.

[Late surgical results in severe craniocerebral trauma with foci of brain crushing]. / Otdalennye rezul'taty khirurgicheskogo lecheniia tiazheloi cherepno-mozgovoi travmy s ochagami razmozheniia golovnogo mozga.

The long-term results of treatment in 130 patients with foci of crushing in the cerebral hemispheres were studied in follow-up periods of 12 months to 12 years. It was established that compensation of the disturbed functions of the central nervous system and the extent of social-occupational adaptation are dependent on the time and volume of the operative intervention, the severity of brain damage, the patients' age, the type and degree of manifestation of the hypertensive-dislocation syndrome, and the application of a complex of intensive therapy measures. A higher level of social-occupational adaptation is achieved when the focus of brain destruction is removed within the bounds of the destruction zone and before the development of the dislocation syndrome.

[Pathogenesis of traumatic subdural hydroma]. / O patogeneze travmaticheskikh subdural'nykh gidrom.

Pathogenetic factors leading to the formation of traumatic subdural hygromas (TSH) are identified from analysis of the results of complex examination of 156 patients. Comparative biochemical tests of CSF, blood serum and the hygroma fluid in 15 patients showed the hygroma to contain CSF. The formation of TSH was always a consequence of brain contusion, usually of a severe degree, and rupture of the basal CSF cisterns. As the result of critical analysis of the existing theories of TSH pathogenesis a new conception is formulated.

[External drainage of the ventricular system of the brain in a complex of intensive therapy of severe craniocerebral injuries]. / Naruzhnyi drenazh zheludochkovyi sistemy golovnogo mozga v komplekse intensivnoi terapii tiazheloi cherepno-mozgovoi travmy.

Indications for draining the ventricular system of the brain in patients with severe craniocerebral injury are given, based on analysis of the clinical neurological signs and the quantitative estimations. The most frequent situations in which drainage is necessary are described. Ventricular drainage should be the final stage of the principal operative intervention, namely, trephination of the skull and removal of intracranial hematomas and foci of brain crushing.

[Quantitative characteristics of cerebral blood flow and gas exchange in cerebral contusions]. / Kolichestvennye kharakteristiki tserebral'nogo krovotoka i gazoobmena pri ushibakh golovnogo mozga.

Statistical characteristics of blood flow and gas exchange parameters in patients with craniocerebral injury grouped in a different manner according to the severity of the contusion, the state of consciousness, and the general condition were obtained by electric computer processing of the results of studying hemispheric blood flow by means of 133Xe clearance in 86 cases, oxygen consumption by the brain in 36 cases, and carbon dioxide excretion by the brain by Van Slyke's method in 75 cases. A close correlation was revealed between the state of the patient's consciousness and the parameters of cerebral blood flow and gas exchange; compression in severe brain contusion was found to have a statistically significant effect on cerebral blood flow and gas exchange.

[Surgical treatment in severe forms of closed craniocerebral injury]. / Khirurgicheskoe lechenie pri tiazelykh formakh zakrytoi cherepno-mozgovoi travmy.

Modern principles of diagnosis and surgical treatment of traumatic intracranial hematomas, subdural liquor hydromas, foci of crushing of cerebral hemispheres and depressed fractures of bones of the cerebral fornix are presented including reference to general surgical and traumatological hospitals. New views to the formation of intracranial hematomas and subdural liquor hydromas are described.

[Local blood flow and metabolism in a focus of cerebral crushing]. / Lokal'nyi krovotok i metabolizm v oblasti ochaga razmozzheniia golovnogo mozga.

Study of ECoG, local cerebral circulation, and brain pO2 in 39 patients in the acute period of severe craniocerebral injury, as well as morphohistochemical measurements around the focus of crushing (in experiments) showed that the transitional zone is a risk zone because the "enzymatic death" of the tissue of this zone occurring at the moment of the injury predetermines extension of the areas of necrosis later on. The most effective measure is the removal not only of the detritus but also of the transitional zone of the focus within the range of tissue that had hardly suffered any changes and the inclusion of vasoactive and dehydration agents in the therapeutic complex.

[Clinico-echoencephalographic correlations in the early diagnosis of traumatic intracranial hematomas and foci of brain crushing]. / Kliniko-ékhoéntsefalograficheskie korreliatsii pri rannee diagnostike travmaticheskikh vnutricherepnykh gematom i ochagov razmozzheniia golovnogo mozga.

The authors examined 254 patients with closed trauma of the skull and brain. Besides clinical examination all patients were subject to unidimensional multiaxial echoencephalography with a modified ultrasonic probe and method of examination Three degrees of brain affection were distinguished according to the clinical signs and three degrees of compression according to the results of echoencephalography, the combination of which allows correct tactics of examination and treatment to be used in patients with severe closed trauma of the skull and brain within the first hours of hospitalization.

[Margins for improving the results of treatment of cranio-cerebral injuries with brain compression]. / Nekotorye rezervy uluchsheniia rezul'tatov lecheniia cherepno-mozgovoi travmy so sdavleniem golovnogo mozga.

Clinical and statistical analysis of information gained from observation over 1 661 patients with craniocerebral injury treated at neurosurgical clinics in 1967-74 confirmed the proposition advanced at the Leningrad Polenov Neurosurgical Institute, namely that operation for correcting compression of the brain by an intracranial hematoma should be performed as early as possible after the injury and no later than 3 hours following hospitalization.

[Time of formation of traumatic intracranial hematomas]. / Vremia obrazovaniia tramaticheskikh vnutricherepnykh gematom.

Biochemical study of the methemoglobin concentration (60 cases) and histological examination (40 of intracranial hematomas removed in different periods after the trauma confirmed the assumption that the main volume of these hematomas forms within the first minutes and hours after the trauma as a rule. The curve of the dependence of the methemoglobin concentration in the hematoma on the time of its formation allows the period of time which had elapsed after the trauma to be determined.

[Visceral pathology in severe cranio-cerebral injuries and its pathogenetic mechanisms]. / Vistseral'naia patologiia pri tiazheloi cherepno-mozgovoi travme i ee patogeneticheskie mekhanizmy.

Pathological conditions of the internal organs and their innervation apparatus, including the limbic cortex, reticular formation, vegetative nuclei of the vagus nerves and spinal cord, peripheral ganglia, and intramural plexuses, in severe craniocerebral trauma were studied by the clinico-physiological, clinico-morphological, and neurohistological methods. The innervation apparatuses of the organs were also studied in experiments with a purposeful effect exerted on the hypothalamus. Peculiarities in the manifestation of visceral pathology in diencephalic and mesencephalobulbar forms of brain lesions were established. Histological changes in the tissues of the organs and in the structures forming the efferent and afferent links of the visceral reflex arc are described. The dependence of the structural disturbances in the central and peripheral components of the vegetative nervous system on hypothalamic affection was confirmed experimentally. Their dynamics was studied. The data of the investigations are discussed from the standpoint of the results of a complex of purposeful surgical and nonoperative treatment of craniocerebral trauma and its complications. Particular attention is focussed on the role of the neuro-conduction mechanism in the development of pathological conditions of the organs. The tissue changes are considered to be neurodystrophic.

[Several pathophysiologic grounds for radical removal of contusion foci from the cerebral hemispheres]. / Nekotorye patofiziologicheskie obosnovaniia radikal'nogo udaleniia kontuzionnykh ochagov bol'shikh polusharii golovnogo mozga.

Local circulation and PO2 of the cerebral tissue were studied in 26 patients during the acute period of a severe craniocerebral trauma. It was demonstrated that pronounced changes in the microcirculation developed in the area of the concussion focus in the cerebral hemispheres. Three zones of disorders in the local circulation were distinguished, and it was shown that in case of an unremoved concussion focus the extending of its necrosis zone took place. The most effective surgical management of patients with severe craniocerebral traumas attended by concussion foci is its radical removal.