[Moyamoya disease in adults: treatment methods in modern era]. / Sovremennyi podkhod k lecheniyu angiopatii moyamoya u vzroslykh.

Moyamoya angiopathy is a chronic progressive cerebrovascular disease characterized by stenosis and occlusion of the distal segments of the internal carotid arteries and/or proximal segments of the middle and anterior cerebral arteries, with a gradual compensatory restructuring of the cerebral circulation to the system of the external carotid arteries. Today, the main treatment method for Moyamoya angiopathy is surgical revascularization of the brain. A search and analysis of publications on the treatment of adult patients with Moyamoya angiopathy was carried out in the PubMed and Medscape databases over the past 10 years. We present a case of an adult female patient with a hemorrhagic form of Moyamoya angiopathy stage IV according to J. Suzuki, who underwent staged combined revascularization of both cerebral hemispheres. Surgical revascularization included the creation of a low-flow extra-intracranial shunt combined with a combination of indirect synangiosis. The combination of direct and indirect methods of surgical revascularization enables to achieve the development of an extensive network of collaterals and fully compensate for cerebral circulatory disorders both in the early and late postoperative periods, which is confirmed by instrumental diagnostic data. Combined revascularization is the most effective modern method of treating patients with Moyamoya angiopathy due to the complementary influence of direct and indirect components of revascularization.

[Long-term postoperative outcomes in patients with drug-resistant epilepsy]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s farmakorezistentnymi formami epilepsii.

Epilepsy surgery is effective in 30-82% of patients with drug-resistant epilepsy. However, risk factors of unfavorable outcomes after epilepsy surgery require further study. OBJECTIVE: To evaluate risk factors of favorable and unfavorable long-term postoperative outcomes in patients with drug-resistant epilepsy. MATERIAL AND METHODS: Postoperative outcomes in a large cohort of patients with epilepsy are reported for the first time in the Russian Federation. There were 271 patients with drug-resistant scheduled for surgery. Preoperative examination and surgical treatment were carried out between January 1, 2014 and December 12, 2019 at the Evdokimov Moscow State University of Medicine and Dentistry and Sklifosovsky Research Institute for Emergency Care. We used Engel grading system to assess postoperative outcomes after 12, 24, 48 and 60 months. We distinguished favorable (Engel I-II) and unfavorable (Engel III-IV) outcomes and analyzed the factors influencing postoperative results in these patients. RESULTS: There were 319 surgical procedures in 271 patients (217 primary resections, implantation of vagus nerve stimulator in 31 patients, 9 redo resections and 8 radiosurgical procedures). Focal cortical dysplasia (FCD) was found in 162 (60%) patients, «dual pathology¼ - in 118 (44%) cases. In 12 months after surgery, favorable outcomes (Engel l-II) were observed in 69% of patients (n=148), after 24 months - in 71% (n=127) of patients. Postoperative complications occurred in 6 (1.9%) patients. There was no mortality. The earlier onset of epilepsy (p=0.01), multifocal (p=0.002) and bilateral lesions (p=0.0038) were the most significant risk factors of unfavorable postoperative outcomes. CONCLUSION: Surgical resection is effective approach for drug-resistant epilepsy.

[Long-term EEG monitoring in patients with acute traumatic brain injury]. / Dlitel'noe monitorirovanie elektroentsefalogrammy u bol'nykh s tyazheloi cherepno-mozgovoi travmoi.

OBJECTIVE: To investigate the informativeness of long-term scalp EEG monitoring in patients with acute traumatic brain injury (TBI). MATERIAL AND METHODS: The informativity of long-term EEG monitoring (LTM) was performed in 60 patients with acute severe TBI. Odd ratios (OR) of unfavorable outcome and non-convulsive status epilepticus (NCSE) among clinical, neurophysiological and radiological features were calculated. RESULTS: EEG features of the unfavorable outcome are: slowing of the dominant background rhythm below q range (OR 3.5, CI 1.2-10.7), absence of frontal-occipital gradient (OR 10.2, CI 1.89-10.12), absence of reactivity (OR 8.75, CI 2.14-35.7), absence of variability (OR 6.25, CI 1.72-22.6) and absence of NREM sleep, stage 2 (OR 5.8, CI 1.79-18.91). Clinical features associated with the unfavorable outcome are: a decrease in GCS score (OR 1.25, CI 1.07-1.47), TBI severity (OR 2.46, CI 1.16-5.18), axial dislocation (OR 4.45, CI 1.08-18.29). ORs for NCSE are significant for the following EEG features: presence of rhythmic and periodic patterns (RPP) (OR 11.92, CI 1.37-103.39), stimulus induced RPP (OR 23.14, CI 2.56-209.34), "plus" modifier (OR 4.11, CI 1.13-14.91) and electrographic evolution (OR 13.05, CI 3.59-47.39). Background rhythm slowing below q range reduces NCSE probability (OR 3.33, CI 1.09-10). CONCLUSION: Long-term EEG monitoring is an informative tool for prognosis of outcome and diagnosis of NCSE in patients with severe TBI. The risk of NCSE increases with Marshall score but NCSE is not associated with poor outcome that requires an individual selection of intensive care.

[Endoscopy-assisted surgical treatment of carotid artery kinking]. / Éndoskopicheski-assistirovannaia korrektsiia patologicheskikh izvitostei sonnykh arterii.

OBJECTIVE: To evaluate the results of endoscopy-assisted surgical treatment of patients with 'high' tortuosity of the ICA. MATERIAL AND METHODS: Endoscopy-assisted surgical reconstruction of high tortuosity of the ICA was made in 11 patients. All procedures were carried out at the Sklifosofsky Research Institute for Emergency Medicine (Moscow) and Republican clinical hospital of Kabardino-Balkaria (Nalchik) for the period from 01.01.18 to 31.12.18. RESULTS: There were no intraoperative and postoperative complications (blood flow velocity increased by 66.2% after surgery). Neurological improvement after surgery was noted in all patients. Partial or complete regression of dizziness was observed in 5 (45.5%) patients. Tinnitus disappeared in 7 (63.6%) patients. CONCLUSION: Approach to the distal parts of ICA is traumatic, requires the use of additional techniques and considerable surgical experience. Endoscopic technique is valuable to reduce the risk of injury of soft tissues, neurovascular structures and improve functional outcomes.

[Posttraumatic seizures: a prospective cohort study]. / Posttravmaticheskie pristupy: prospektivnoe kogortnoe issledovanie.

AIM: To evaluate the incidence and risk factors for posttraumatic seizures (PTS). MATERIAL AND METHODS: The authors conducted a prospective study of 237 patients with TBI of varying severity. The patients were hospitalized and examined in Moscow neurosurgery departments. Then they participated in the follow-up observation for 2 years. PTS were classified as early (occurred from 1 to 7 days after TBI) and late (occurred later than 7 days). RESULTS AND CONCLUSION: Forty-three people (18.1%) experienced early seizures, 15 patients (6.3%) had late seizures. The early seizures were the significant predictor of the late seizures. In the group of patients with early seizures, the proportion of severe TBI was significantly higher. Subdural hematoma, depressed skull fracture, alcohol abuse were reliable predictors of early and late PTS. Thus, these factors increased the risk of posttraumatic epilepsy (PTE).