Электрофизиологические аспекты малоинвазивного способа лечения невралгии тройничного нерва

Brain-steam acoustic evoked potentials (BAEP) study was carried out in 84 patients with chronic-pain syndrome due to trigeminal neuralgia (TN). Preoperative BAEP changes were detected in all patients with TN. There were no specific differences in BAEP among variants of the disease course preoperatively. Percutaneous radiofrequency termocoagulation of Gasserian ganglion could be explored in all etiological types of TN. The lesion in trigeminal ganglion raised functional activity in the brain-stem part of the antinociceptive system. The radiofrequency lesion blocked the afferent pulsation from a peripheral part. It both relieved the severe pain and restored the damaged sanogenetic mechanism of pain suppression. Unrestorable BAEPs postoperatively were a prognostic factor for the pain relapse in patients with TN.Проведено исследование коротколатентных стволовых акустических вызванных потенциалов у 84 пациентов с хроническим болевым синдромом невралгии тройничного нерва (НТН) на этапах комплексного лечения. Полученные данные определяют прогноз рецидива боли в послеоперационном периоде, при этом не выявлено специфических отличий между разными вариантами течения заболевания на этапе предоперационного исследования. Это позволяет использовать малоинвазивный метод парциальной радиочастотной деструкции гассерова узла независимо от патогенетического типа невралгии (периферического или центрального), так как воздействие на периферический отдел системы повышает функциональную активность стволового отдела антиноцицептивной системы. Радиочастотная деструкция прерывает сформированный патологический замкнутый круг, блокируя афферентную импульсацию из периферического отдела, тем самым не только избавляет от мучительных болей, но и восстанавливает поврежденный саногенетический механизм антиноцицепции

INITIAL RESULTS IN RECURRENT BRAIN GLIOBLASTOMAS MANAGEMENT WITH MAXIMAL SAFE RESECTION FOLLOWED BY INTAOPERATIVE BALLOON ELECTRONIC BRACHYTERAPY

Brain glioblastomas (GBM) are notorious for their early local recurrence despite of standard combined treatment. Technologies for recurrent GBM management require further development and research. Resection of malignant gliomas must be followed by an adjuvant treatment. Intraoperative balloon electronic brachytherapy (IBEB) has been recently introduced into clinical practice and could be successfully applied to recurrent GBM management. This article presents the initial results of recurrent GBM management with maximal safe resection followed by IBEB. Material and methods. Patients (n = 11) with recurrent GBM after standard combined treatment were managed with maximal safe microsurgical resection followed by IBEB. The follow-up period after IBEB ranged from 1 to 30 months. Results. The median overall survival for the entire study group of patients included in the statistical analysis (n = 9) was 27 months (range 17–47 months). In the subgroup of patients (n = 4) with contrast-enhanced tumor MRI volume after resection ≤ 2.5 cm3, the median local progression free survival (locPFS) was 21.25 months (range 10–30 months). Conclusion. Initial results in recurrent brain GBMs management with resection followed by IBEB seems to be promising, especially in case of contrast-enhanced tumor volume detected on MRI after resection is less than 2.5 cm3 without signs of multifocal tumor growth

Modern approaches and diagnostic tools in neurosurgical practice: a case of patient with intracranial hypotension and secondary cervical spine degeneration

We report a case of a 47-years old woman presented to our department with the diagnosis of Chiari I malformation and extensive hydrosyringomyelia. Her main complains were severe headache and chronic pain syndrome in the left side of her breast and left arm. Magnetic resonance imaging (MRI) showed alterations suggestive of the presence of intracranial hypotension (IH), that was confirmed by measurement of cerebrospinal fluid (CSF) opening pressure and then CSF venous fistula was detected by computed tomography myelography (CTM). She was successfully surgically treated which leaded to the regression of the clinical symptoms and radiological alterations. Nevertheless, during her recovery after surgery she had an episode of recurrent left arm pain, which was interpreted as secondary cervical spine degeneration consequence. MRI confirmed C5-C6 disc herniation and transforaminal epidural injection of local anesthetic and corticosteroid solutions was performed. A week later she already felt significant improvement as her pain syndrome regressed a lot. IH should be considered in the differential diagnosis of headache and sagging brainstem and tonsils with cord syrinx on MRI and should not be misinterpreted as Chiari malformation. At the same time, transforaminal epidural injection appears to be an effective tool in modern neurosurgical practice allowing to determine the reason and accurate radiculopathy level

Family Clustering of Viliuisk Encephalomyelitis in Traditional and New Geographic Regions

Transmission occurs through patient contact; human migration from disease-endemic villages leads to disease emergence in new communities

Stent-assisted coiling of acute ruptured cerebral aneurysms

The necessity of quick surgical treatment of acute ruptured cerebral aneurysms was demonstrated in large studies by the ISAT and ISUIA, which also proved the advantage of the endovascular method over the surgical one. Ballonassistence is widely used in treatment of aneurysms with wide neck and unfavorable vascular anatomy, but the radicality of the treatment is insufficient. The aim of this study was to demonstrate the efficacy and safety of stent-assisted embolization of «acute» cerebral aneurysms. Material and methods. A retrospective analysis of the treatment of 234 patients with «acute» cerebral aneurysms was carried out. Results. Only coils were used in 40.6 % of cases (n = 95), balloon-assistance, in 40.2 % of cases (n = 94), and stent-assistance, in 19.2 % of cases (n = 45). There were 11.5 % (n = 27) clinically significant complications. Total aneurysm occlusion (Raymond-Roy I) was achieved in 187 cases (79.9 %); the radicality at the control examination was 67.1 % (157 patients). Discussion. The radicality of the treatment with stents was slightly higher then with balloons and coils at the end of operation (84.4 %, n = 38 and 78.8 %, n = 149, p > 0.05), but it was significantly higher at the control examination (80.0 %, n = 36 and 60.8 %, n = 115, respectively, p <0.05). Also, we had no statistically significant difference of the complication rate in the «stent» and «no stent» groups; therefore, the clinical outcomes of endovascular treatment of cerebral aneurysms did not depend on the choice of treatment method. Conclusions. Intracranial stents allow achieving good results of the embolization of complex aneurysms in the acute period of intracranial hemorrhage without increasing the risk of surgical treatment

Genetic insights into the social organization of Neanderthals

Genomic analyses of Neanderthals have previously provided insights into their population history and relationship to modern humans1–8, but the social organization of Neanderthal communities remains poorly understood. Here we present genetic data for 13 Neanderthals from two Middle Palaeolithic sites in the Altai Mountains of southern Siberia: 11 from Chagyrskaya Cave9,10 and 2 from Okladnikov Cave11—making this one of the largest genetic studies of a Neanderthal population to date. We used hybridization capture to obtain genome-wide nuclear data, as well as mitochondrial and Y-chromosome sequences. Some Chagyrskaya individuals were closely related, including a father–daughter pair and a pair of second-degree relatives, indicating that at least some of the individuals lived at the same time. Up to one-third of these individuals’ genomes had long segments of homozygosity, suggesting that the Chagyrskaya Neanderthals were part of a small community. In addition, the Y-chromosome diversity is an order of magnitude lower than the mitochondrial diversity, a pattern that we found is best explained by female migration between communities. Thus, the genetic data presented here provide a detailed documentation of the social organization of an isolated Neanderthal community at the easternmost extent of their known range

Радиочастотная термодеструкция симпатического ствола в лечении хронических облитерирующих заболеваний артерий нижних конечностей

The 81 patients suffering from chronic arterial insufficiency of lower extremities (LE) dueto obliterating atherosclerosis (OA) underwent surgical sympathectomy at L2 , L 3, L4 lumbar level on the side of lesion. Radiofrequency thermodestruction (RF) was used in 60 patients, open sympathectomy was perfomed in 21 patiens. Pain relief was achieved in all patients. Dopplerography data demonsrated the improvement of blood flow in LE. This study had showed high efficiency of RF in treatment of patients with OA.This procedure is less traumatic than open сympathectomy.Проведено хирургическое лечение 81 пациенту с хронической артериальной недостаточностью нижних конечностей вследствие облитерирующего атеросклероза путем воздействия на симпатические узлы поясничного уровня L2, L3, L4 на стороне поражения. Из них 60 больным проведена радиочастотная термодеструкция (РЧТД), 21 больному проводилась открытая операция симпатэктомии. У всех больных отмечено уменьшение болевого синдрома и положительная динамика по данным доплерографического исследования артериального кровотока в нижних конечностях. Метод радиочастотной термодеструкции при высокой клинической эффективности менее травматичен, чем открытая симпатэктомия

Tumor inflating lymphocytes. Purification, expanding and cytotoxicity analisys on primary tumor cultures

Background. Tumor Infiltrating Lymphocytes (TILs) is one of the most promising sources of autologous cytotoxic T-cells for adoptive immunotherapy, which has already shown high efficiency in the treatment of metastatic melanoma. However, the isolation of TILs from solid tumors is technically difficult. A suppressive tumor microenvironment, in particular, a high level of expression of check-point inhibitors PD-1 CTLA4, tissue hypoxia and other factors cause that T cells isolated from the tumor do not proliferate well and do not exhibit cytotoxic properties. Aims. In this study, we isolated TILs from surgical material obtained by resection of solid tumors (primary and metastatic adenocarcinomas of various localization, melanoma, glioblastoma), studied their population composition and developed protocols for the purification expanding, and activation of CD4+, CD8+ cytotoxic antitumor lymphocytes. Methods. An urgent task is the activation of TILs, turning off immunosuppressive mechanisms and increasing their antitumor cytotoxic activity. Various approaches are used for this: activation by a cocktail of cytokines and antibodies, editing the lymphocyte genome by knocking out suppressor genes or, conversely, transduction of activating genes, coincubation with feeder cells, etc. Cells were obtained from samples of resected tumors in 16 patients; in each case we obtain an autologous pair: the primary tumor culture and the TILs culture. Results. We could isolate viable lymphocytes in 100% of cases. Isolated TILs were successfully expanded in our specialized medium using various combinations of IL-2, IL-15, IL-21, IL-7, anti-CD3 and anti-CD28. Immunophenotyping showed that the obtained TILs are a heterogeneous mixture of CD4+, CD8+ cells containing populations of CD3+CD8+CD45+(CTL) CD3+CD4+CD45+ (T-helpers), CD4+CD25+CD127- (Т-regulatory cells), CD3-CD56+CD45+ (NK-cells), CD3+CD56+CD45+ (Т-NK-cells). The initial cultures of TILs were also characterized by a high level of PD1 expression, indicating their low antitumor cytotoxicity. Using different protocols of isolation, expansion, and activation, we obtained a cell preparation containing 80% of CD8+ PD-1- activated TILs in an amount sufficient for adoptive therapy (500106 or more). An in vitro study of the cytotoxicity of obtained TILs in primary cultures of homologous tumors using RTCA Icelligence showed high cytotoxicity, providing almost 100% tumor cell death. Conclusion. Our developed protocol for the production and activation of TILs can be recommended for the phase III clinical trials of adoptive immunotherapy of recurrent, highly metastatic solid tumors

Влияние молекулярно-генетического профиля менингиом на течение заболевания и рецидивирование при использовании комбинированного метода лечения

Introduction. Meningioma is one of the most common central nervous system tumors, accounting for 39.7 % of all primary brain tumors. The tumor originates from arachnoid meningothelial cells and is characterized by a wide range of histological types classified into 15 subtypes. The histological classification of meningiomas allows us to predict meningioma behavior and the risk of disease recurrence, as well as to define treatment strategies. However, clinical outcomes in histological subgroups of patients are often inconsistent with the histological grade of malignancy. Thus, a more reliable method is needed both to determine the histological subtype of the tumor and to predict the clinical course of the disease with the potential for targeted treatment.The purpose of the study was to summarize the available data on the effect of results of the genomic and proteomic tumor analysis on carcinogenesis with the relationship between the mutational changes and noninvasive diagnosis, treatment and the course of the disease.Material and Methods. Literature search was carried out in the PubMed, Elibrary system, publications were included mainly from 2010 to 2023. with the identification of articles by the keyword “genetic analysis of meningiomas” and synonyms. 550 articles were found, of which 55 were used to write a literature review.Conclusion. The study of the molecular genetic profile of meningiomas will improve the classification and establish a correlation with MRI data, the course of the disease and prognosis.Введение. Менингиома, одна из самых распространенных опухолей центральной нервной системы, составляет 39,7 % всех выявляемых первичных опухолей головного мозга. Источником возникновения этих новообразований являются менинготелиальные клетки паутинной оболочки. Менингиомы отличаются широким спектром гистологических вариантов, что выражается в наличии 15 гистоподтипов. Гистологическая классификация менингиом позволяет предположить дальнейшее развитие заболевания, спрогнозировать риски рецидива опухоли, определить тактику ведения пациента. Однако клинические исходы в гистологических подгруппах пациентов часто противоречат гистологической градации злокачественности. Таким образом, необходим более надежный метод как для определения гистологического подтипа опухоли, так и для прогнозирования клинического течения заболевания с потенциалом для таргетного лечения.Цель исследования – обобщить литературные данные о влиянии результата геномного и протеомного анализа опухоли на канцерогенез с определением взаимосвязи данных мутационных изменений с неинвазивной диагностикой, лечением и течением заболевания.Материал и методы. Поиск литературы производился в системе PubMed, Elibrary, включались публикации преимущественно с 2010 по 2023 г. с идентификацией статей по ключевому слову «генетический анализ менингиом» и синонимами. Найдено 550 источников, из которых 55 использовано для написания литературного обзора. Ряд статей, опубликованных ранее 2010 г., использованы для исторической справки о методах лечения и диагностики. Данные статьи не включали информацию о генетическом аспекте публикации.Заключение. Продолжение изучения молекулярно-генетического профиля менингиом, в том числе, возможно, измененного под воздействием комплексного лечения, позволит усовершенствовать классификацию и определить корреляционную зависимость между морфологическим, молекулярно-генетическим профилем опухоли, структурой менингиомы на основе анализа данных МРТ и клиническим течением заболевания