Neurosurgical anatomy of the insula and Sylvian fissure in gliomas: literature data and own experience. The first report. Arteries

Insular gliomas account for 25 % of all low-grade and 10 % of all high-grade gliomas. This complex neural and vascular anatomy of the insula and subinsular areas and the attendant risk of postoperative neurological deficit render resection of insular gliomas challenging. Postoperative morbidity can result from injury to these arteries. The cortex and adjacent subcortical structures of the insula are supplied with blood from the cortical insular perforating arteries and lenticulostriate arteries. The source of both types of arteries is the middle cerebral artery. To preserve these vessels, it is necessary to take into account their location while performing approach and tumor debulking.The presurgical planning is extremely important for insular glioma surgery, which allows predicting the extent of removal and to assess the risk of postoperative morbidity. The digital subtractive angiography, CT angiography, MRI angiography make a full picture of the tumor relationship with the lenticulostriate arteries while it is almost impossible to identify the tumor involvement of the insular arteries.The aim of insular glioma surgery is to achieve total removal while preserving critical arteries. This goal is complicated both by a small diameter of lenticulostriate and insular arteries, which intraoperatively complicates their identification and their involvement in tumor tissue. The intraoperative neuroimaging, neuronavigation, intraoperative neuromonitoring can help guide the extent of resection and prevent or minimize postoperative morbidity. However, these advanced technologies are often insufficient without a comprehensive understanding of the insular functional and vascular anatomy

Use of algorithm of the prevention complex of inflammatory processes in the oral cavity in metabolic syndrome

The aim of the work was to evaluate in the experiment the effectiveness of the developed treatment-and-prophylactic complex for the prevention of periodontal tissue disorders under metabolic syndrome simulation. Materials and methods. The study of biochemical and immunological changes in the blood serum, liver and gingival tissue was performed during simulation on the metabolic syndrome of alimentary genesis on Wistar rats, all animals were divided into 5 groups: 1) intact; 2) with simulated metabolic syndrome; 3) in a week after the start of MS simulation 5 times a week in the morning perorally administered a “Capillaroprotect” aqueous solution (bioflavonoid, antioxidant) produced by “Ekosvit Oil” (Ukraine) at a rate of 135 mg/kg; 4) under similar conditions receiving the preparation based on the dihydroquercetin were locally applied on gums a new dental elixir based on bee products and adaptogens of plant origin by 0,5 ml/rat with a tampon, which has held for 5–7 minutes; 5) during MS simulation from the second week were used the preparation based on the dihydroquercetin, the dental elixir topically on gums and physiotherapy. Results. Under conditions of experimental MS simulation with a diet rich in saturated fats and carbohydrate there are systemic disorders in the body: reduced nonspecific antimicrobial protection, increased microbial contamination, intensification of lipid peroxidation, the development of inflammation and hepatotoxicity. Prophylactic administration of the proposed dihydroquercetin preparation to animals in the process of simulation of MS significantly inhibits the established disorders, positively affecting the biochemical parameters of the blood serum, liver tissue, periodontium, reducing triglycerides, total cholesterol, glucose level, restoring the state of non-specific resistance, lipid metabolism, preventing inflammation and hepatosis, as well as contamination with pathogenic microflora. Conclusion. The proposed treatment-and-prophylactic complex, which includes the dihydroquercetin preparation, used per os in combination with local therapy of periodontal tissues with a tooth elixir based on propolis and biologically active substances of plant origin adaptogens with ultraphonophoresis under induced metabolic syndrome significantly removed the negative effects of its most important component

Застосування мультимодальної нейронавігації в хірургії пухлин головного мозку

The experience of multimodal neuronavigation using at patients with brain tumors surgical treatment is presented. Multimodal neuronavigation allows simultaneous using of different neuroiradiological methods’ data for surgical intervention planning before operation and intraoperative orientation at brain tumors resection. The use of neuronavigation in neurooncology allows to improve tumor resection, to avoid damage of functionally important brain areas, and to reduce the risk of postoperative neurological deficit.Приведен опыт применения мультимодальной нейронавигации при хирургическом лечении больных с опухолями головного мозга. Мультимодальная нейронавигация позволяет одномоментно использовать данные различных методов нейровизуализации для дооперационного планирования хирургического вмешательства и интраоперационной ориентации при удалении опухолей головного мозга. Применение нейронавигации в нейроонкологии способствует повышению радикальности хирургического вмешательства, позволяет избежать повреждения функционально важных структур головного мозга, обеспечивает снижение риска возникновения послеоперационного неврологического дефицита.Наведений досвід застосування мультимодальної нейронавігації при хірургічному лікуванні хворих з пухлинами головного мозку. Мультимодальна нейронавігація дозволяє одномоментно використовувати дані різних методів нейровізуалізації для доопераційного планування хірургічного втручання та інтраопераційної орієнтації під час видалення пухлин головного мозку. Застосування нейронавігації в нейроонкології сприяє підвищенню радикальності хірургічного втручання, дозволяє уникнути пошкодження функціонально важливих структур головного мозку, забезпечує зниження ризику виникнення неврологічного дефіциту

Time factor role estimation in combined treatment of primary malignant brain tumours

The effectiveness of postoperative radiotherapy in patients with primary malignant brain tumours treatment was analysed. The dependence of life duration and quality, radio reactions frequency and severity on the terms of postoperative irradiation

Substantiation of indications for the third molar’ follicle removing, taking into account violations of occlusal relations

Целью исследования было повышение эффективности профилактики нарушений окклюзионных соотношений путем обоснования показаний по удалению третьих моляров. Изучены механизмы формирования нарушений окклюзионных взаимоотношений (мезиальная, дистальная окклюзии) при формировании и прорезывании импактных третьих моляров, а также оболочка фолликулов третьих моляров. Изучены изменения в височно-нижнечелюстном суставе при формировании окклюзионных взаимоотношений при формировании и прорезывании третьих моляров. Изучены морфологические особенности тканей, окружающих импактные третьи моляры на момент их формирования и прорезывания. Уточнены сведения о факторах, влияющих на процесс формирования нарушений окклюзионных взаимоотношений при формировании и прорезывании импактных третьих моляров. Уточнены показатели ферментативных изменений и показатели биоценоза в полости рта при формировании и прорезывании импактных третьих моляров.The aim of the investigation was to increase the effectiveness of prevention of violations of occlusal relations by substantiating the indications for the removal of third molars. The mechanisms of formation of occlusal relationships (mesial, distal occlusion) during the formation and eruption of impacted third molars, as well as the shell of third molar follicles have been studied. Changes in the temporomandibular joint in the formation of occlusal relationships in the creation and eruption of third molars have been studied. The morphological features of the tissues surrounding the impacted third molars at the time of their formation and eruption have been studied. Updated information on the factors influencing the process of formation of violations of occlusal relationships in the formation and eruption of impact third molars. The indicators of enzymatic changes and indicators of biocenosis in the oral cavity during the formation and eruption of impact third molars have been specified

Показники якості життя в оцінці ефективності лікування хворих з гліальними пухлинами півкуль великого мозку

In the process of patients with gliomas complex treatment their quality of life was researched. It was found that before treatment the life quality was estimated as low and medium, it depended on localization, gystobiology, preoperative neurological deficit severity, age and gender. After postoperative treatment patients quantity with Karnofsky scale index 70 scores and more grew up to 37,2%, with medium and high levels of life quality by the social-psychology adaptation scale increased to 39%.Изучены показатели качества жизни (КЖ) у 532 больных с глиомой головного мозга (ГГМ) в процессе комплексного лечения. Установлено, что КЖ зависит от локализации, гистобиологических свойств опухоли, выраженности дооперационного неврологического дефицита, возраста и пола. После проведения послеоперационных реабилитационных мероприятий число больных, у которых индекс Karnofsky превышал 70 баллов, увеличилось на 37,2%, число больных, у которых показатели КЖ по шкале социально-психологической адаптации соответствовали «среднему» и «высокому» уровню — на 39%.Вивчені показники якості життя (ЯЖ) у 532 хворих з гліомою головного мозку у процесі комплексного лікування. Встановлено, що ЯЖ залежить від локалізації, гістобіологічних властивостей пухлини, вираженості доопераційного неврологічного дефіциту, віку і статі. Після проведення реабілітаційних заходів кількість хворих, у яких індекс Karnofsky перевищував 70 балів, збільшилась на 37,2%, з середнім і високим рівнем ЯЖ за шкалою соціально-психологічної адаптації зросла — 39%

Changes in the structure of synaptic intercellular contacts in focal brain lesions

Purpose: to evaluate changes in the structure of synaptic contacts in various types of focal brain pathology. Materials and methods. The results of treatment of 40 cases of supratentorial focal lesions of the brain (FLB) were retrospectively evaluated. The cases are divided into groups: 30 gliomas of various degrees of malignancy and 5 consequences of TBI, 5 epilepsy. All patients underwent surgical interventions. The synaptic plasticity of axo-dendritic and axo-spiny asymmetric synapses of neurons of the VI-VII layers of the frontotemporal cortex was studied by electron microscopy. Morphometric analysis was carried out on a computer image analyzer САИ-01АВН using the software "Kappa opto-electronics GmbH" using the STATISTICA 7 program package. The results. It was established that the density of synapses decreased in glioblastomas (GB) and craniocerebral injury (ССІ). Qualitative changes demonstrate the plasticity of architectonics of synapse, in particular due to the increase in the number of perforated synaptic contacts. Maximum thickening and diffuse stratification of the postsynaptic seal indicates a violation of the functional capacity of the postsynaptic component of the contacts. A decrease in the number of synaptic vesicles was revealed in ССІ and GB, with their rearrangement, which is probably a manifestation of synaptic dysfunction. The latter proves the irreversibility of destructive local changes and is unfavorable criterion. The risk of the formation of destructive-degenerative changes in the synaptic apparatus is 7.64 times higher in DA, 3.17 times higher in GB, and 17.31 times higher in ССІ compared to cases of epilepsy, with GB significantly increases by 13.5 times compared to DA. Therefore, the assessment of the structural features of neuroplasticity should take into account the morphogenesis of the BM in comparison with clinical data Conclusions. In the zones of invasive growth of gliomas of various degrees of malignancy and in ССІ and epilepsy, the indicators of synaptic plasticity differ statistically significantly. The density of placement of synapses is lower in GB and ССІ. The probability of non-reversibility of destructive-degenerative changes of synapses according to the number of SVs in FLB correlates with the degree of glioma differentiation with a sensitivity of 81.0% and a specificity of 76.0%. According to the structural changes of synaptic connections in tumors, probable differences between the variants have been proven: GB and DA, the sensitivity of the discriminant model is 85.0%, the specificity is 74.0%, which is an indirect evidence of the growth rate of the tumor mass and its destructive effect on the surrounding brain matter. The obtained results are important in assessing the prognosis of the further course of the disease

Neurosurgical anatomy of the insula and Sylvian fissure in gliomas: literature review and personal experience. The second report. Veins

Insular gliomas account for 25% of all low-grade and 10% of high-grade gliomas. Neurosurgical treatment of insular gliomas involves achieving the maximum possible volume of tumor removal while ensuring high quality of life. The anatomical proximity of functionally important brain structures and the involvement of important insular arteries and veins limits the possibility of radical removal of tumors. The key to the effectiveness of surgical intervention in insular gliomas is the selection and implementation of adequate surgical access surgical access. The most commonly used approach to insular gliomas is transsylvian-transinsular. The implementation of this approach is largely determined by the individual characteristics of the venous system of the sylvian fissure, since it is characterized by extreme anatomical variability in particular, the type of outflow direction dominance, the number of veins, their size, type of branching, drainage, collateral connections. The review presents data on the informativeness of modern methods of instrumental research in the assessment of the venous system of the sylvian fissure and insula with the aim of planning surgery for insular gliomas. Methods of preserving venous collectors of the sylvian fissure and possible complications associated with the exclusion of draining veins from the circulation are described