Posttraumatic pneumacephalus: etiopathogenesis, diagnostics, methods of surgical treatment. Clinical case

Studying an opportunity to optimize the treatment of the patients with severe traumatic brain injuries is a topical issue in modern neurosurgery. Traumatic tension pneumocephalus is one of life-threatening conditions which accompanies severe TB1 and is often complicated with posttraumatic liquorrhea and mass effect. Materials and methods. We carried out systematic search in Russian and foreign medical databases (Medline, Russian Science Citation Index, EMedicine, UMKB) concerning our theme. We included the following words in our search request: tension pneumocephalus, mass effect, valve mechanism, treatment. The result of conducted review of literature was writing the clinic lecture, studying current status of the problem of etiopathogenesis, diagnostics and surveillance of the patients with tension pneumocephalus. The article presenas clinical case of successful surgical treatment of a patient with traumatic tension pneumocephalus. Conclusion. There are no uniform standards of urveillance of the patients with tension pneumocephalus. Based on our own experience, we determined that minimally invasive surgery is a method of choice among reconstructive craniofacial surgeries in the treatment of patients with traumatic tension pneumocephalus. It decreases the risks of intra- and postoperative complication. Compliance, using external ventricular drainage and repeated lumbar punctures with prevention of inflammatory complications helped stopping nasal liquorrhea and eliminating mass effect which caused absolute regression of neurological signs

PERIARTICULAR CYSTS OF FACET JOINTS: ETIOPATHOGENESIS, DIAGNOSIS, METHODS OF SURGICAL TREATMENT. A CLINICAL EXAMPLE

Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes  words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical  treatment. One of the significant factors of PC development is the  instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with  periarticular cysts of facet joints was studied. The article gives a  clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being  a radical and effective way of treatment. A detailed study of this  pathology is a promising direction in spinal neurosurgery. Further  research is required on comparative analysis of clinical and  instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints

Development of an algorithm for the clinical and instrumental diagnosis of non-compression lumbar pain syndromes to optimize the use of puncture surgical techniques

Background. Pain syndromes developing as a result of degeneration of the lumbar segments of the spine constitute a significant problem in modern vertebrology. The results of the application of preoperative diagnostic provocative tests are contradictory, and therefore the mixed effectiveness of puncture surgical techniques is recorded.Objective. To develop an algorithm for the clinical and instrumental diagnosis of non-compression lumbar pain syndromes to optimize the use of puncture surgical techniques.Material and Methods. The study included 923 patients who underwent provocative diagnostic techniques on the intervertebral disk (IVD) and the arched joints (AJ) between 2012 and 2017. Taking into account clinical and instrumental data, the following are made: in group I (n=246) – laser IVD nucleoplasty, in group II (n = 287) – laser denervation of FJ, in group III (n = 390) – simultaneous use of laser exposure to IVD and AJ. We analyzed the dynamics of the level of pain in the lumbar spine and lower extremities according to The Visual Analogue Scale and quality of life according to The Short Form-36 (SF-36) questionnaire.Results. When performing provocative diagnostic tests, the minimum number of adverse effects was recorded: 3.2% in group I, 2.4% in group II, and 2.1% in group III. After puncture methods of surgical treatment, a significant persistent decrease in the severity of preoperative pain was observed both in the lumbar spine (p = 0.002, p = 0.005 and p = 0.004, respectively) and in the lower extremities (p = 0.003, p = 0.001 and p = 0.005, respectively) A significant improvement in the physical and psychological components of health was also established in group I (p = 0.02 and p = 0.01, respectively), in group II (p = 0.01 and p = 0.03, respectively) and group III (p = 0.03 and p = 0.02, respectively).Conclusion. In the presence of neuroimaging parameters of IVD according to C. Pfirrmann III–IV and protrusion size 4–6 mm, minimal degenerative changes in the AJ according to A. Fujiwara I–II and D. Weishaupt I–II, as well as a positive disruption test, it is possible to perform laser nucleoplasty. In case of detection of neuroimaging data of IVD according to C. Pfirrmann I–II and protrusion size less than 4 mm, moderately pronounced degenerative changes in the AJ according to A. Fujiwara II–III and D. Weishaupt II–III, as well as positive paraarticular stimulation of AJ, laser denervation of AJ is recommended. When determining, according to neuroimaging data, moderate degenerative changes in IVD according to C. Pfirrmann over III and protrusion size 4–6 mm, as well as degeneration of AJ according to A. Fujiwara more than II and D. Weishaupt more than II, positive of samples and paraarticular stimulation of AJ, it is advisable to perform simultaneous surgical intervention in the volume of laser IVD nucleoplasty and laser denervation of AJ

ANALYSIS OF FACETOPLASTY APPLICATION FOR ISOLATED FACET SYNDROME IN PATIENTS WITH DEGENERATIVE DISEASE OF ZYGAPOPHYSIAL JOINTS OF THE LUMBAR SPINE

Background. Degenerative diseases of zygapophysial joints of the lumbar spine are the main reason of a resistant facet syndrome in 70–85% of the population older 40 years. This research was aimed to carry out an analysis of results after facetoplasty used for treating patients with degenerative diseases of zygapophysial joints of the lumbar spine.Material and methods. The research included 128 patients at the age of 41 (35.5; 46) years with degenerative diseases of zygapophysial joints of the lumbar spine and clinical manifestations in the form of an isolated facet syndrome. They have had puncture of zygapophysial joints with intra articulate introduction of joint fluid prosthesis (facetoplasty) within the period from 2015 to 2017. We used a visual analogue scale of pain and the Osvestri questionnaire for patients with problems in the back to assess clinical efficiency. Dynamic assessment was made in average in 24 months after the operation.Results. As a result it is found out that the facetoplasty is an effective mini-invasive method for facet syndrome treatment, caused by degenerative diseases of zygapophysial joints of the lumbar spine.Conclusion. Usage of facetoplasty in patients with isolated FS caused by degenerative disease of zygapophysial joints of the lumbar spine allows to observe sufficient clinical outcomes within immediate and long-term postoperative periods

Ratio of elements in humic acids as a source of information on the environment of soil formation

This paper considers the informative importance of one of the main features that characterize humic acids of soils at the diagnosis of the natural environment of their formation in both the present and the past. It is shown that the ratio of elements in the humic acids clearly corresponds to the landscape conditions and quantitative characteristics of climatic parameters. They persist over time and can serve as one of the reliable indicators in assessing the environment of different periods of paleogeographic history. © 2012 Pleiades Publishing, Ltd