[Invasive EEG for temporal lobe epilepsy: selection of technique]. / Invazivnyi video-EEG monitoring pri visochnoi epilepsii: vybor metoda.

BACKGROUND: Non-invasive EEG reveals epileptogenic zone in 70% of patients. In other cases, invasive EEG monitoring is indicated. Various implantation strategies and techniques of intracranial EEG (icEEG) potentially provide different outcomes. Choosing the optimal icEEG technique may be challenging. OBJECTIVE: To analyze the results of icEEG in adults with temporal lobe epilepsy and to determine the algorithm for selection of optimal invasive EEG technique. MATERIAL AND METHODS: The study included 82 patients with temporal lobe epilepsy who underwent invasive EEG. Effectiveness of invasive EEG was determined by detection of epileptogenic zone and post-resection outcomes. Postoperative results were analyzed throughout more than 6-month follow-up period using the Engel grading system. Statistical analysis was conducted using the Fisher's exact test. RESULTS: Epileptogenic zone was revealed in 72 (88%) cases. Invasive EEG was supplemented by another modality in 3 (4%) patients. Mean follow-up period after resection was 17 months in 45 patients. Favorable outcomes were achieved in 31 (69%) cases. Statistical analysis showed that identification of epileptogenic zone depends existing of lesion and symptoms of seizures. Selection algorithm for optimal technique of invasive EEG was determined considering own results and literature data. CONCLUSION: Invasive EEG results and post-resection outcomes demonstrated favorable efficacy of original algorithm. The last one may be used in decision-making on optimal technique of invasive EEG in adults with temporal lobe epilepsy.

[Chronic spinal stimulation in treatment of lower limb critical ischaemia syndrome]. / Khronicheskaia spinal'naia stimuliatsiia v lechenii sindroma kriticheskoi ishemii nizhnikh konechnostei.

Obliterating peripheral artery disease is a commonly occurring pathological condition, most often resulting from an atherosclerotic lesion of vessels with progressive narrowing of their lumens. The consequences of decompensation of chronic arterial insufficiency such as ischaemic pain, claudication, and trophic impairments are in some instances difficult to treat, despite using multicomponent medicamentous therapy and/or performing revascularizing interventions. This article describes a clinical case report regarding the use of spinal stimulation in a patient presenting with stage IV chronic lower limb ischaemia according to the Fontaine classification. This is accompanied and followed by depicting the dynamics of the laboratory, instrumental, and clinical parameters over a two-year follow-up period. In order to explain the choice of the intervention and the causes of the described picture, discussed are the existing theories of the mechanisms of action of spinal stimulation. To this is added a literature review of using this method in treatment of lower limb critical ischaemia when performing reconstructive angiosurgical treatment is unavailable. Mention is also made of the incidence and types of probable complications, as well as possibilities and limitations of the method.

[Early postoperative results of surgical treatment of patients with anterior clinoidal meningiomas]. / Rannie rezul'taty khirurgicheskogo lecheniya patsientov s meningiomami perednego naklonennogo otrostka.

Resection of anterior clinoidal meningiomas is a challenging task due to their localization, frequent involvement of the major cerebral arteries and cranial nerves, a high risk of postoperative neurological deficits, and low radicalness of surgery. AIM: To evaluate the radicalness of microsurgical removal and a neurological deficit in the early postoperative period in patients with anterior clinoidal meningiomas. MATERIAL AND METHODS: A total of 35 patients with anterior clinoidal meningiomas underwent surgery at the Department of Neurooncology of the Novosibirsk Federal Neurosurgical Center in the period from 2013 to July 2016. There were 29 (82.9%) females and 6 (17.1%) males. The mean patient age was 50.1 years (31-72 years). According to the Al-Mefty classification (1990), type 1 tumors occurred in 10 (28.6%) patients, type 2 tumors were in 22 (62.8%) patients, and type 3 tumors were in 3 (8.6%) patients. Twenty four (68.6%) patients had large (greater than 4.0 cm) tumors, 7 (20.0%) patients had medium (2.0-4.0 cm) tumors, and 4 (11.4%) patients had small (less than 2.0 cm) meningiomas. The tumor involved the major arteries in 21 (60.0%) patients. RESULTS: The lateral supraorbital approach was used in 26 (74.3%) patients, and the pterional approach was used in 9 (25.7%) cases. The tumor was resected totally (Simpson II) in 25 (71.4%) cases and subtotally (Simpson IV, subtype A and B) in 10 (28.6%) patients. In the early postoperative period, cerebral symptoms regressed in 20 (57.1%) patients; visual acuity improved in 2 of 13 (15.4%) patients. Four (11.4%) patients developed IIIrd nerve palsy; 2 (5.7%) patients developed severe hemiparesis. The mortality rate was 2.9%. CONCLUSION: The completeness of resection directly depends on the tumor consistency: soft meningiomas can be totally resected (Simpson II) with a good functional outcome. In the case of solid tumors, total resection may lead to serious ischemic disorders with a high risk of death.

[Evaluation of short-term surgical outcomes in facial paralysis patients treated by trigeminal neurotization]. / Otsenka blizhaishikh rezul'tatov khirurgicheskogo lecheniya bol'nykh s litsevym paralichom metodom trigeminal'noi nevrotizatsii.

UNLABELLED: The management of patients with facial nerve palsy is a challenge of modern neurosurgery. The study purpose was to evaluate the degree of facial nerve function recovery, following trigeminal neurotization. Trigeminal neurotization was performed in 23 patients within 1 to 10 months after the development of facial paralysis. In most cases, the cause of facial paralysis was surgery for space-occupying lesions of the cerebellopontine angle (95.6%). Outcomes of trigeminal neurotization were evaluated in 17 (73.9%) patients who were followed-up for more than 6 months. In 16 (94.1%) patients, the facial nerve function was recovered to a House-Brackmann grade III-IV. Given the surgery RESULTS: we can say that trigeminal neurotization is one of the effective treatments for facial paralysis. In most cases, this technique has provided good outcomes without additional complications, which is important for this group of patients.

[Spinal cord stimulation in the treatment of chronic pain syndromes].

AIM: The study objective was to estimate the efficacy of chronic epidural spinal cord stimulation in the treatment of patients with neuropathic pain syndrome. MATERIAL AND METHODS: A system for chronic spinal cord stimulation (St. Jude) was implanted to 75 patients with neuropathic pain syndrome. Fifty three (70.7%) patients were diagnosed with failed back surgery syndrome (FBSS); 9 (12.0%) patients had complex regional pain syndrome type II; 4 (5.3%) patients had diabetic polyneuropathy of the lower limbs; 3 (4.0%) patients had idiopathic pelvic-perineal pain; 2 (2.7%) patients had spinal stroke pain; 2 (2.7%) patients had postherpetic intercostal neuralgia; 1 (1.3%) patient had stump pain; 1 (1.3%) patient had spinal cord injury pain. The treatment efficacy was evaluated using the visual analog scale (VAS) and DN4 questionnaire. The follow-up period ranged from 6 to 18 months. RESULTS: 136 patients underwent test stimulation at the Center in 2014. A significant reduction in pain was observed in 75 (55.1%) patients. These patients underwent the second stage of surgery that included implantation of permanent electrodes and a generator. The mean VAS score was 6.5 (maximum: 10; minimum: 5) before surgery, 3.2 at discharge, and 3.1 after 3 and 6 months. The VAS score amounted to 3.6 after 12 months. Complications in the form of pain at the generator implantation site and the need for removal of the system occurred in 2 patients (2.6%), electrode migration was observed in 4 (5.3%) cases. CONCLUSION: Chronic epidural spinal cord stimulation is an effective and safe technique for the treatment of drug-resistant chronic neurogenic pain syndromes.

[The preliminary results of subthalamic nucleus stimulation after destructive surgery in Parkinson's disease]. / Predvaritel'nye rezul'taty stimulyatsii subtalamicheskogo yadra posle destruktivnykh operatsii pri bolezni Parkinsona.

OBJECTIVE: To evaluate the efficacy of bilateral electrical stimulation (ES) of the subthalamic nucleus (STN) in patients with Parkinson's disease (PD) after preceding pallidotomy or ventrolateral (VL) thalamotomy. MATERIAL AND METHODS: The study included 9 patients with bilateral STN ES who had undergone previous unilateral destructive surgery on the subcortical structures: pallidotomy (5 patients) and VL thalamotomy (4). A control group consisted of 9 patients with STN ES, without prior destructive surgery. A clinical and neurological examination included quantitative assessment of motor disturbances using the Hoehn-Yahr scale and Unified Parkinson's disease rating scale (UPDRS). UPDRS was used to evaluate the motor activity (IIIrd part of the scale) and severity of drug-induced dyskinesia and motor fluctuations (IVth part of the scale). RESULTS: In the group of STN ES with preceding destruction of the subcortical structures, an improvement in motor functions in the early period (6 months) was 45%, and severity of drug-induced complications was decreased by 75%. In a group of STN DBS without destruction, motor disturbances were improved by 61%, and drug-induced complications were decreased by 77%. Improvement in motor functions amounted to 51.9% in patients with preceding pallidotomy (GPi destruction) and 37.5% in a group with preceding VL thalamotomy. The equivalent dose of levodopa was reduced by 51.39%, from 1,008±346 to 490±194, in the study group and by 55.04%, from 963±96 to 433±160, in the control group. CONCLUSION: Bilateral STN neurostimulation is effective after unilateral stereotaxic destruction of the subcortical structures in PD patients.