[Long-term results of surgical treatment of patients with cerebral arterial aneurysms]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s arterial'nymi anevrizmami golovnogo mozga.

OBJECTIVE: To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period. MATERIAL AND METHODS: A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS. RESULTS: The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (p<0.05) and the risk of dementia by 6 times (p<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (p<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (p<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (p<0.05). CONCLUSION: The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.

[Endovascular treatment of acute ischemic stroke]. / Éndovaskuliarnoe lechenie ishemicheskogo insul'ta v ostrom periode.

Ischemic stroke is one of the leading causes of mortality and disability in the population of developed countries. Revascularization of the affected cerebral territory improves the prognosis and reduces mortality, which has been proven by randomized studies using systemic thrombolysis protocols. Over the last ten years, endovascular mechanical thrombus extraction using stent retrievers and/or aspiration neurointerventional catheters has been introduced into the clinical treatment of ischemic stroke, and after reporting the results of randomized studies on this topic, the technique has become ubiquitous. This work objective was to systematize the results of key studies on the treatment of acute ischemic stroke in chronological order, including the latest data of 2018.

[HYPOTHERMIA INFLUENCES ON OXYGEN TENSION IN THE BRAIN PARENCHYMA IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE].

Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself

[Initial experience of treatment of primary intraocular lymphomas associated with primary CNS lymphomas].

Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.

[Successful treatment of moya-moya disease using encephalo-duro-arteriosynangiosis].

Aim of the study was to demonstrate the possibility of effective surgical revascularization of the brain in children with moya-moya disease. 3 year old girl with moya-moya disease underwent encephalo-duro-arteriosynangiosis. At 14 months follow-up signs and symptoms of cerebral ischemia totally resolved. Angiography confirmed brain supply from external carotid artery via the newly formed anastomotic network. Authors emphasize the necessity to seek moyamoya disease in children with symptoms of brain ischemia to allow timely and effective surgical treatment.

[Malignant lymphoma of the central nervous system and eye].

Intraocular lymphoma was encountered in 11.4% of the 79 examined patients with malignant lymphoma of the central nervous system. In most cases it had occurred long on an average of 26 months before the development of neurological manifestations and the diagnosis of cerebral lymphoma. Biomicroscopy showed intraocular lymphoma to manifest itself as corneal endothelial precipitation of translucent corpuscles, opacity of the vitreous body, and its posterior detachment. Isolated intraocular lymphoma has been misinterpreted as uveitis of unclear etiology. In this connection, resistance to steroidal and antibacterial therapy should be an indication for diagnostic vitrectomy, followed by an immunohistochemical study of a biopsy specimen. The intraarterial administration of methotrexate, by breaking the blood-brain barrier, caused regression of cerebral lymphoma, but did not result in that of intraocular lymphoma, on this basis the authors consider the intravitreal injection of the agent to be indicated.