[Microsurgical selective neurotomy in treatment of the focal spastic syndromes of the different etiology]. / Mikrokhirurgicheskaia selektivnaia nevrotomiia v lechenii fokal'nykh spasticheskikh sindromov razlichnoi étiologii.

OBJECT: To estimate the effectiveness of selective peripheral neurotomy (SPN) in the treatment of local botuloresistant spastic disorders. METHODS: 20 SPNs were performed in 18 patients with spastic disorders. In 11 cases we performed SPN of the nervus obturatorius, in 5 - tibialis, in 3 - musculocutaneous, in 1 - radialis. The results of surgical treatment were estimated by the Ashworth scale and GMFM-88. These data was statistically processed. RESULTS: There was a significant decrease of spasticity in most cases: from 4,02±0,52 points before surgery to 1,86±0,63 points after surgery (p<0,001). In 11 cases we observed significant improvement in motor functions: from 50,7±12,92% before surgery to 54,9±13,6% after surgery (p<0,001). CONCLUSION: SPN is an effective procedure which leads to significant reduction of spasticity, improvement in movement range motor functions in patients with spastic disorders.

[Cervical spondylogenic myelopathy: diagnostics, treatment, prognosis].

The authors present a review of literature focusing on state-of-art of surgical management of cervical spondylogenic myelopathy (CSM). Pathophysiology of CSM, evaluation and differential diagnosis are also described. Special attention is given to the value of neurophysiological aspects in pre- and postoperative examination.

[Multiple echinococcosis of brain, heart and kidneys].

The authors report a rare case of multiple echinococcosis (brain, heart and kidneys). Neuronavigation, intraoperative ultrasound scanning have allowed to plan exact and non-traumatic access to the cysts. Microsurgical technique and intraoperative neurophysiological monitoring provided removal of seven cysts without their rupture from the left parietooccipital and right parietal area with good postoperative functional result. Serologic analysis of antibodies with antigens of echinococci and histological research confirmed the diagnosis of cystic echinococcosis.

[Tethered cord syndrome in different types of spina bifida in children].

BACKGROUND: Tethered cord syndrome (TCS) occurs in 10-75% of children after correction of myelomeningocele and lipomyelomeningocele. Early diagnosis and surgical treatment of TCS after correction of different types of spina bifida remains a challenging problem of modern neurosurgery. MATERIALS AND METHODS: Since January till December 2008 in Burdenko Neurosurgical Institute 15 children were prospectively examined and operated. All of them had TCS after surgical treatment of spina bifida: myelomeningocele--7 (47%), lipomyelomeningocele--4 (27%), meningoradiculocele--1 (7%), meningocele--2 (13%), diastematomyelia--1 (7%). In the analyzed series peak of TCS manifestation was within 4 and 12 years. RESULTS: Clinical presentation of the disease consisted of neurological, urological, proctological and orthopaedic syndromes. In the postoperative period positive results were observed in most cases: regression of pain syndrome in 7 cases (87.5%), increase of muscle strength--in 4 (57%), improvement of sensory function--in 2 (33.3%), full or partial improvement of bladder and rectal function--in 4 (33.3%) and 5 (41.7%), respectively. Surgical complications occurred in 7 patients (46%): would CSF leak in 3 (20%), pseudomeningocele in 1 (6.7%), transient urinary retention in 2 (13.3%), wound insufficiency due to CSF leak in 1 (6.7%), motor deterioration in 1 (6.7%). CONCLUSION: Early surgical treatment of TCS in most cases leads to stabilization or improvement of neurological status. Risk of surgical complications associated with CSF leak indicates that optimal ways of their prevention should be developed.

[Planning of surgical approach to intracerebral tumors of the hemispheres using fMRI, neuronavigation, and electrophysiological monitoring].

The paper discusses pre- and intraoperative application of different guiding techniques (frameless neuronavigation, fMRI, electrophysiological monitoring). We performed comparative analysis of different combinations of these methods. 74 patients with intracerebral tumors involving eloquent areas (sensorimotor cortex in 56 and speech zones in 18) were operated. In 9 cases 'awake surgery' was applied. We found that frameless navigation combined with brain mapping allows to optimize planning of surgical approach and to decrease postoperative neurological deficit. Also in certain cases 'awake craniotomy' can be replaced by fMRI and neuronavigation.