[Microsurgical treatment of cerebral arteriovenous malformations in Burdenko Neurosurgical Institute (recent experience)].

Recently the number of AVM resections in Burdenko Neurosurgical Institute has been increased dramatically. Aim of this study was to assess the results of open surgery in our clinic in modern neurosurgical era. Consecutive series if 160 patients with AVM treated using microsurgical technique since 2009 till 2011 was analyzed. Spetzler-Martin score distribution was: grade I--29 (18.1%) cases, grade II--84 (52.5%), grade III--38 (23.8%), grade IV--9 (5.6%). Patients with grade V AVMs were not operated. Treatment options included: AVM resection in 143 (89.4%) cases, embolization followed by resection in 15 (9.3%) and clipping of afferents in 2 (1.3%). Glasgow outcome scale score distribution was the following: V (good recovery)--70 (43.7%), IV (moderate disability)--71 (44.4%), III (severe disability)--16 (10%), II (vegetative state)--1 (0.6%) and I (death)--2 (1.3%). Microsurgery remains the primary option for radical treatment of cerebral AVMs. Careful selection of patients and planning of surgery are crucial for good outcomes.

[Ventriculoperitoneal and ventriculoatrial shunts in treatment of patients with brain tumors].

Two 234 patients with tumor-associated hydrocephalus underwent their first shunt implantation at Burdenko Neurosurgery Institute between 2004 and 2008. Age of the patients ranged from 18 to 77 years (mean 44). The follow-up was available in 162 patients (72%). The median follow-up was 10 months. Shunt failure occurred in 29,2% of 162 patients. Kaplan-Mayer analysis showed that the probability of shunt failure free interval was 72, 69, 60% at one, two and three years after insertion, respectively. The most frequent cause of shunt failure was malposition of the ventricular catheter (30,6%), occlusion of the ventricular and abdominal catheter occurred in 20,4 and 22,2%, respectively. Shunt infection was encountered in 24,5% of cases. Among the analyzed factors (position of the catheter within the ventricle, additional operations such as tumor resection, implantation of external ventricular drain before shunt surgery, malignancy of the tumor and type of hydrocephalus) only presence of external ventricular drain increased the risk of shunt infection. The duration of external drainage positively correlated with the risk of shunt infection. In most cases shunt failure can be prevented. The results of the study may help the surgeon to choose the optimal treatment strategy for patient with tumor-associated hydrocephalus.

[The clinical and epidemiological characteristics of acute brain injury in children of the Republic of Kabardino-Balkaria].

The paper provides the data of an epidemiological survey for acute brain injury in the pediatric population in Nalchik (Republic of Kabardino-Balkaria) during 3 years (1991-1993). The incidence of acute brain injury was 4.32 +/- 0.30, 5.13 +/- 0.34, and 5.44 +/- 0.36 per 1000 children in 2001, 2002, and 2003, respectively, i.e. there is a statistically significant trend for the figures to increase (t = 2.39; p < 0.01). The death of victims was caused by their severe condition and mortality rates were 0.91; those due to brain contusion and compression were 2.68. The paper also presents the structure of victims by the severity of injury and by the differentiation of these parameters by age, and the relationship of craniocerebral traumatism to a number of social factors. Particular emphasis is laid on the quality of specialized aid. The minimum required diagnostic equipment is determined for the correct evaluation of the severity of injury. Algorithms of delivering care to children depending to their age are given, which make the work of an admission department physician easier, reduce the number of diagnostic and therapeutic errors, and promote a reduction in economic costs. The findings enable one to gain an idea of the level of craniocerebral traumatism and to define measures to improve health care.

[The classification of nervous system tumors]. / Klassifikatsiia opukholei nervnoi sistemy.

The paper presents the classification of tumors of the nervous system, which is based on the Second Variant of the International Histological Classification of Tumors of the Nervous System which was developed by the WHO experts in 1993 and on the section "Morphology of Neoplasms" of the International Classification of Diseases, Xth review. These classifications were critically reviewed by taking into account the experience gained by the Laboratory of Pathomorphology, Academician N. N. Burdenko Research Institute, Russian Academy of Medical Sciences. The proposed classification may unify the material of our country's neurosurgical clinics and provide more corrective statistic data.

[Epidemiological and classification aspects of nervous system tumors]. / Nekotorye aspekty épidemiologii i klassifikatsii opukholei nervnoi sistemy.

The data obtained from various surveys of the epidemiology of the CNS tumors in different countries were analyzed. It was noted, the incidence of primary CNS tumors remains within the limits of 5-12.5 cases per 100,000 people, and depends on number of factors (e.g. sex, age, place of residence, etc.). Metastases double the incidence of all CNS tumors. The estimated incidence of tumors of the nervous system in Russia and particularly Moscow are given in the paper. The analysis of the data cells for the improvement in the organization of the medical care of this group of patients. With this respect the second WHO histological classification of CNS tumors (WHO, 1993) is critically analyzed. Based on the experience at the Burdenko Neurosurgical Institute (over 10,000 brain biopsies), a modified WHO neuropathological classification is suggested. The classification may be useful in research projects, and may facilitate the diagnosis, treatment, rehabilitation, and final assessment of the outcome. Series of documents of this kind help to make the evaluation of the activities of neurosurgical departments more objective, as well as to make the statistics more reliable.

[Methodological problems and various results of the study of the incidence and structure of diseases of the urinary system among adult population (data from outpatient clinics of Moscow, Celinograd and the Celinograd district of the Kazakh SSR)]. / Metodicheskie voprosy i nekotorye rezul'taty izucheniia chastoty i struktury boleznei mochevydelitel'noi sistemy sredi vzroslogo naseleniia (na primere terapevticheskikh uchastkov Moskvy, Tselinograda i Tselinogradskoi oblasti Kazakhskoi SSR).

A 4-stage system of mass screening of population for the detection of renal diseases tested in one of the outpatient clinic zones in Moscow (2013 residents), Thelinograd (7091 residents), and Tselinograd Region, Kazakh SSR (880 residents) was presented. The incidence rates of renal diseases per 1000 examined population in Moscow, Tselinograd and Thelinograd Region, Kazakh SSR, were 12.4 +/- 2.5, 10.4 +/- 1.2, 13.6 +/- 3.9, respectively.

[Principles for making the diagnosis of craniocerebral injury]. / Printsipy postroeniia diagnoza pri cherepno-mozgovoi travme.

The structure of the diagnosis of craniocerebral trauma in the acute period was elaborated in conformity with its common clinical classification. The authors substantiate the necessity for supplementing the general nosological characteristics of the injuries to the skull and brain with a specification of all anatomical and principal functional components of the trauma, which are listed in order of their importance for the therapeutic policy and the outcomes.