[Tubular retractors for transcranial approaches to intraaxial brain tumors in children]. / Opyt primeneniya tubulyarnykh retraktorov v transkranial'noi khirurgii intraaksial'nykh opukholei golovnogo mozga u detei.

Reduction of surgical trauma associated with approach to deep brain structures including resection of tumors is an urgent direction in development of techniques and technology. OBJECTIVE: To analyze the efficacy and safety of tubular retractors in surgery of deep brain tumors in children. MATERIAL AND METHODS: The study included 17 children with deep brain tumors who underwent surgery between 2020 and 2021. Tubular retractors were used in all cases. The control group consisted of 15 children with a similar disease and standard intraoperative tissue traction technique. All patients underwent MRI of the brain on the first postoperative day. We analyzed severity of traction-induced damage to brain tissue in T2 FLAIR and DWI images. RESULTS: Clinical outcomes and structure of surgical complications were similar in both groups. Tubular retractor turned out to be a tool reducing traction injury. In the main group, postoperative MRI revealed significantly less damage to brain tissue along surgical approach in T2 (edema zone) and DWI (ischemic changes) images.

[Keyhole surgery for giant basal brain tumors. Theoretical explanation with an example of trans-eyebrow subraorbital approach]. / Aktual'nost' keyhole-dostupov v khirurgii gigantskikh opukholei osnovaniya golovnogo mozga. Teoreticheskoe obosnovanie na primere chrezbrovnogo supraorbital'nogo dostupa.

BACKGROUND: Improvement of modern neurosurgical technology has given rise to keyhole surgery for a wide range of pathologies. Supraorbital trans-eyebrow approach has been described in detail for small tumors of anterior cranial fossa and suprasellar neoplasms. Can we use this small and less traumatic approach for a more complex tumor extending beyond the suprasellar region? OBJECTIVE: To analyze own experience of surgical treatment of large and giant parasellar tumors via supraorbital approach, to identify the principles of such operations, indications and possible limitations. MATERIAL AND METHODS: There were 58 resections of parasellar tumors via mini-supraorbital approach had been performed between 2016 and 2021 at the 2nd pediatric neurosurgical department. We selected 42 patients with large and giant tumors extending beyond the chiasmal-sellar zone and causing occlusive hydrocephalus (mean volume 44.2 cm3). Preoperative status of patients, postoperative clinical data and logistics of in-hospital treatment were analyzed. RESULTS: Total resection was performed in all cases. No redo surgeries or revisions were required. There were no cases of wound infection, CSF leakage and damage to large vessels. CONCLUSION: We standardized planning of surgeries for large neoplasms considering available knowledge about the nature of diseases, analysis of clinical and X-ray data, goals and objectives of surgery. The reader is offered a theoretical substantiation of applicability of keyhole surgery for chiasmal-sellar tumors on the example of well-known mini-supraorbital approach. We gave certain advices on planning such operations and illustrated clinical examples.

[PLGA mesh-collagen hybrid scaffold and tissue-engineered product in substitution urethroplasty: experimental validation].

Urethral strictures are a pressing issue in modern medicine. Substitution urethroplasty is considered one of the most effective treatment methods. However, despite the surgery showing good results, many problems remain unresolved, one being substitute material deficiency in extensive or recurrent strictures, as well as in cases requiring multistage surgeries, including those used to treat hypospadias. Graft removal also leaves the donor area prone to diseases and increases the length of surgery leading to a higher risk of intra- and postoperative complications. Tissue engineering (namely tissue-engineered products comprised of scaffolds and cells) may be a useful tool in dealing with these issues. The authors assessed the characteristics of a novel hybrid scaffold created from "reconstructed" collagen and a poly(lactic-co-glycolic acid) mesh. The resulting composite product showed good mechanical properties and functional performance. The hybrid scaffold was non-cytotoxic and provided an adequate base for cell adhesion and proliferation. Biodegradation resulted in the scaffold being replaced by urothelium and urethral mucosa. The newly formed tissues possessed adequate structural and functional properties. Only one rabbit out of 12 developed urethral stricture at the site of scaffold implantation. The above-mentioned facts suggest that the novel hybrid scaffold is a promising tissue-engineered product with potential implication in substitution urethroplasty.