[Metallic foreign bodies of brain ventricles]. / Metallicheskie inorodnye tela zheludochkov golovnogo mozga.

Head injuries are often associated with intracranial foreign bodies that require decision making on the need for certain surgical treatment. Intraventricular foreign bodies are rare, so the question of surgical tactics is still open. OBJECTIVE: To summarize the experience of treating the wounded with intraventricular foreign bodies. MATERIAL AND METHODS: Treatment outcomes in victims with foreign bodies in lateral ventricles are presented. Searching in the e-Library, PubMed, Google Scholar databases included the following keywords: «penetrating wounds¼, «foreign bodies¼, «cerebral ventricles¼, «gunshot injury¼, «ventricular foreign bodies¼. We analyzed data on the treatment of victims with intraventricular foreign bodies. RESULTS: Three victims underwent surgery, and foreign bodies were removed from the occipital horn of the lateral ventricle, third ventricle and temporal horn of the lateral ventricle. Conservative approach was preferred in 1 case. Follow-up ranged from 1 month to 7 years, GOS score - 3-4 points. Disability was due to severe injury and not associated with surgical treatment per se. We found 16 publications matching the searching criteria. Treatment methods varied from standard surgical approaches to stereotactic management. The indication for removal of foreign bodies was their migration through the ventricular system and occlusive hydrocephalus. None patient had neurological aggravation. CONCLUSION: Intraventricular foreign bodies are rare and present certain difficulties in choosing the method and timing of treatment. Indications for their removal are migration, occlusive hydrocephalus and infectious complications. The method of removal is determined depending on location, magnetic properties, nature of injury, surgical preferences and other factors.

[Combat gunshot skull and brain injuries]. / Boevye ognestrel'nye raneniya cherepa i golovnogo mozga.

There have been over 15 ended and ongoing armed conflicts in the world between 2014 and 2020. The total number of irrecoverable losses in these conflicts exceeded 800 000 people. In modern conflicts, gunshot head wounds account for 37.4% of sanitary losses of surgical profile. These injuries are characterized by high mortality rate. Changes in fighting nature entail changes in structure of wounds and treatment approaches. OBJECTIVE: To analyze treatment strategy and features of surgical interventions for combat gunshot head injuries considering literature data for the period from 2014 to 2020. MATERIAL AND METHODS: We analyzed the PubMed and eLibrary databases using the following keywords: head gunshot wound, traumatic brain injury, head trauma, combat trauma, wartime injury. We selected the reviews, original articles and case reports devoted to head gunshot wound management for the period 2014-2020. Manuscripts in Russian, Ukrainian and English with available abstract and/or full-text article were reviewed. Data on the incidence and structure of craniocerebral injuries, mortality and treatment strategy were analyzed. RESULTS: We found 24 publications matching searching criteria. The majority of manuscripts were devoted to craniocerebral wounds received by combatants and civilians during the hostilities in the south-east of Ukraine (7 manuscripts), in Iraq and Afghanistan (4 manuscripts), as well as in the Syrian Arab Republic (12 manuscripts). Craniocerebral wounds occupy a leading position in overall structure of gunshot wounds and result the highest mortality compared to other wounds. There is a tendency towards the prevalence of bullet wounds over splinter wounds. CONCLUSION: Modern wars and armed conflicts are characterized by changes in the structure of gunshot wounds. Craniocerebral injuries are ones of the most severe and characterized by high mortality. Data on their incidence and structure of gunshot craniocerebral wounds are advisable to be used in planning and organizing care for the wounded, as well as for development of preventive measures.

[Middle meningeal artery embolization for chronic subdural haematoma. Case series and literature review]. / Embolizatsiya srednei obolochechnoi arterii kak metod lecheniya khronicheskikh subdural'nykh gematom. Seriya klinicheskikh sluchaev i obzor literatury.

Middle meningeal artery embolization as primary method for treatment of chronic subdural hematomas became more popular in past decade. There are few large case series (>150 patients) and literature reviews characterizing advantages and drawbacks of endovascular treatment and technical features of surgeries. In this manuscript, the authors report 11 patients with chronic subdural hematoma scheduled for middle meningeal artery embolization and review the literature data on this issue.

[Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch's windows: transpedicular and translaminar sequestrectomy (ridit analysis)]. / Dve taktiki lecheniya poyasnichnykh gryzh mezhpozvonkovykh diskov s migratsiei v zonu vtorogo i tret'ego okna po Makkalloku: transpedikulyarnaya i translaminarnaya sekvestrektomiya (ridit-analiz).

A ridit analysis of results of transpedicular endoscopic and translaminar microsurgical surgeries for sequester migration to the second and third McCulloch's windows was carried out. The authors assessed pain syndrome, quality of life and neurological impairment. OBJECTIVE: To compare the outcomes of transpedicular and translaminar sequestrectomy for lumbar disc herniation and sequester migration to the second and third McCulloch's windows. MATERIAL AND METHODS: We analyzed treatment outcomes in 51 patients with lumbar disc herniation and severe sequester migration. We assessed lumbar and leg pain syndrome using then visual analogue scale, neurological impairment using the adapted Nurik scale and quality of life using the Oswestry questionnaire and the MacNab scale in early postoperative period, as well as in 2 weeks, 6 and 12 months after surgery. Ridit analysis was used for statistical processing of data. RESULTS: Transpedicular sequestrectomy was performed in 24 patients, translaminar sequestrectomy - in 27 cases. Groups were comparable by gender, size and location of sequestration, somatic and neurological status, as well as pain severity. There was a higher probability of back (0.39) and leg (0.364) pain regression, neurological recovery (0.446) and improvement of quality of life according to the Oswestry questionnaire (0.389) after transpedicular surgery. According to the MacNab scoring system, excellent and good results were obtained in 84.21% and 15.79% of patients in 6 months after transpedicular surgery. In the second group, excellent, good and satisfactory results were obtained in 63%, 25.9% and 11.1% of patients, respectively. CONCLUSION: Herniated intervertebral discs with severe sequester migration should be divided in accordance with localization of the main sequestration. Transpedicular endoscopic approach is advisable for sequester in the third and rarely the second McCulloch's windows. Translaminar microsurgical approach is preferred for sequestration in the second and rarely the third McCulloch's windows. Clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries are similar. However, postoperative back and leg pain regression, neurological recovery and improvement of quality of life according to the Oswestry scoring system are more common after transpedicular surgery.

[Cysts of septum pellucidum, cavum vergae and cavum veli interpositi. Meta-analysis of 368 cases]. / Kisty prozrachnoi peregorodki, polosti Verge i promezhutochnogo parusa. Metaanaliz 368 klinicheskikh sluchaev.

OBJECTIVE: To review and systematize literature data on the incidence of cysts of septum pellucidum, cavum vergae and cavum veli interpositi, their clinical manifestations, indications for surgical treatment and optimal surgical approach. MATERIAL AND METHODS: An analysis included 72 manuscripts devoted to epidemiology, pathophysiology, clinical symptoms and results of surgical treatment of brain cysts. Case reports, series of cases, reviews and original studies were analyzed. RESULTS: Septum pellucidum cavity is always formed throughout an embryogenesis and persists in 20.34% of adults. Cavum vergae is observed in 2.32% of adults. Cyst of septum pellucidum is detected in 0.04% of adults. Analysis of 368 cases of cysts of septum pellucidum, cavum vergae and cavum veli interpositi has shown that clinical picture consists of headache (50% of cases), convulsive syndrome (23.6%), reduced intelligence (20.1%), behavioural disorders (15.8%), dizziness, nausea and vomiting (10.9%). Hydrocephalus occurs in 16.6% of cases. Endoscopic wall fenestration is preferred for cyst management. CONCLUSION: Brain cysts are rare and characterized by non-specific clinical manifestations. Symptomatic cyst is an indication for surgical treatment. Surgical treatment usually ensures regression of symptoms and low risk of complications.

[Traumatic occlusion of posterior cerebral artery with occipital lobe ischemia]. / Travmaticheskaya okklyuziya zadnei mozgovoi arterii s ishemiei zatylochnoi doli.

Traumatic cerebrovascular injury (TCVI) are rare, severe and dangerous complications of traumatic brain injuries. Current data suggests they accompany less then 2% of severe traumatic brain injuries. Most common forms of TCVI are formation of traumatic pseudoaneurysms and dural arteriovenous fistulas, less frequent - traumatic occlusions, intersections and some others. This pathology complicates the course of traumatic brain injury, decreases quality of life and prognosis, and requires complex diagnosis and treatment strategy. The authors describe a rare case of traumatic posterior cerebral artery occlusion in a patient injured in a road traffic accident and provide literature review on modern concepts of TCVI.

[Relations between the phagocytic activity of monocytes and the lateralization of brain injuries]. / Zavisimost' fagotsitarnoi aktivnosti monotsitov ot lateralizatsii povrezhdenii golovnogo mozga.

According to the authors' opinion, the different character of alterations in phagocytic activity of monocytes in primary derangement of the dominant and subdominant hemispheres results from the different functional significance of the hemispheres. The most pronounced neurogenous immune dysfunction occurs because of an injury to the dominant hemisphere. The two mechanisms of alterations in phagocytic activity of monocytes are of importance during the posttraumatic period in severe brain contusions: the central one related to neurogenous immune dysfunction and secondary one related to infectious complications.

[The reactivity of the mononuclear phagocytes in the acute period of craniocerebral trauma]. / Reaktivnost' mononuklearnykh fagotsitov v ostrom periode cherepno-mozgovoi travmy.

The article analyses the condition of one of the main links of the defence status--the cells of the mononuclear phagocytotic system in the acute period of craniocerebral trauma (CCT). The authors established the existence of a dependence of the functional condition of the peripheral blood monocytes on the CCT severity. Disorders of the monocyte functional condition (phagocytosis, monocyte test) were most marked in a severe CCT. Early (in the first 24 hours after the trauma) activation of mononuclears develops in such case. Standard nonspecific response of monocytes to traumatic damage is maintained in mild CCT.

[Short-latency brain-stem auditory evoked potentials in patients with a brain concussion]. / Korotkolatentnye slukhovye stvolovye vyzvannye potentsialy u bol'nykh s sotriaseniem golovnogo mozga.

The short-latent acoustic stem potentials were examined in 72 males aged 9 to 61 years (mean 32.3 +/- 10.2 years) with concussion of the brain in different early posttraumatic periods (0.5-15 days). The clinical picture of the victims was characterized by systemic cerebral and mild transient symptoms of involvement of stem regions of the brain. Two thirds of the patients were found to have decreased rates of conduction of electric pulses along the acoustic pathway of the brain stem. Moreover, a fourth of the victims had a retarded perception of acoustic stimuli, which implies that concussion of the brain led to the decreased function of the auditory nerve and all relay nuclei of the acoustic system of the brain. The normal pattern of short-latent acoustic stem evoked potentials was seen in 8.3%, their mild and moderate abnormal changes were observed in 40.3 and 51.4% of the patients. Prolongation of a latent period and interpeak intervals, the deformation and lack of waves were considered to be criteria for abnormal changes in short-latent acoustic stem evoked potentials.

[The use of inflow-outflow drainage after cerebral operations]. / Primenenie pritochno-ottochnogo drenirovaniia posle tserebral'nykh operatsii.

The paper provides strong evidence for the use of inflow-outflow drainage after brain operations and presents an analysis of 255 cerebral operations using various draining modes. The inflow-outflow drainage after brain operations is found to be promising in terms of clinical manifestations. The authors propose their own draining tube for inflow-outflow drainage. A comprehensive macro- and microscopic study of dialysis fluid is recommended. The presence of visible impurities in the dialysate, daily mass of cerebral detritus and the functional activity of granulocytes and mononuclear cells were assessed. A significant early sign has been identified when the inflow-outflow drainage system was applied during occurring local infectious complications by analysing the adhesive properties of mononuclear and polynuclear phagocytes of the dialysate.

[The characteristics of drainage after operations on the brain]. / Osobennosti drenirovaniia posle operatsii na golovnom mozge.

The article discusses the actual problems of surgical wounds drainage in different brain diseases and traumas associated with brain illness. The processes occurring in surgical brain wound are analyzed: edema, swelling, hemorrhage, local immune reactions, difficult venous outflow, hyperproduction of liquor. Demands of cerebral wounds drainage are substantiated.