Особенности периоперационного ведения пожилых больных при эндоскопическом транссфеноидальном удалении опухолей хиазмально-селлярной области

Nowadays, in the age of rapid introduction of digital and fiber-optic technologies in neurosurgery, a technique for removal of tumors in the chiasmatic-sellar area via an endoscopic transsphenoidal endonasal approach is actively developed; this technique is considered less invasive and is well tolerated by patients, thus permitting to operate patients with somatic complications, as well as the elderly. Taking into account these facts, as well as world statistic data indicating a continuous trend of population aging in developed countries, including Russia, optimization of the perioperative care of elderly patients with a tumor of the chiasmatic-sellar area becomes the problem of highest priority. In order to solve it, this review discusses the basic peculiarities of the perioperative management of elderly patients (characteristics of their somatic status and possible variants of the pre-operational state) with a pathology in the chiasmatic-sellar region; it also presents the modern and most acceptable alternative solutions of this difficult problem (introduction of modern methods of anesthesia, management of the postoperative cognitive dysfunction, postoperative pain syndrome, and postoperative nausea and vomiting). В наши дни, в век бурного внедрения в нейрохирургию цифровых и оптико-волоконных технологий, активно развивается метод удаления опухолей хиазмально-селлярной области эндоскопическим эндоназальным транссфеноидальным доступом, который считается малотравматичным и хорошо переносится больными, в результате чего расширияется возможность оперировать соматически отягощенных больных, а также людей старшей возрастной группы. Учитывая эти факты, а также данные мировой статистики, указывающие на неуклонную тенденцию старения населения в развитых странах, в том числе и в России, оптимизация периоперационного ведения пожилых больных, имеющих опухоль хиазмально-селлярной области, становится наиболее приоритетной задачей. Для ее решения в данной статье рассмотрены основные нюансы периоперационного ведения пожилых больных, имеющих патологию хиазмально-селлярной области: особенности их соматического статуса и возможные варианты их предоперационного состояния. Также представлены современные и наиболее приемлемые альтернативные варианты решения этой непростой проблемы: внедрение современных методик анестезии, борьба с послеоперационной когнитивной дисфункцией, послеоперационным болевым синдромом и послеоперационной тошнотой и рвотой.

Peculiarities of the Perioperative Care of Elderly Patients Undergoing Endoscopic Transsphenoidal Removal of Tumors in the Chiasmatic-Sellar Area

Nowadays, in the age of rapid introduction of digital and fiber-optic technologies in neurosurgery, a technique for removal of tumors in the chiasmatic-sellar area via an endoscopic transsphenoidal endonasal approach is actively developed; this technique is considered less invasive and is well tolerated by patients, thus permitting to operate patients with somatic complications, as well as the elderly. Taking into account these facts, as well as world statistic data indicating a continuous trend of population aging in developed countries, including Russia, optimization of the perioperative care of elderly patients with a tumor of the chiasmatic-sellar area becomes the problem of highest priority. In order to solve it, this review discusses the basic peculiarities of the perioperative management of elderly patients (characteristics of their somatic status and possible variants of the pre-operational state) with a pathology in the chiasmatic-sellar region; it also presents the modern and most acceptable alternative solutions of this difficult problem (introduction of modern methods of anesthesia, management of the postoperative cognitive dysfunction, postoperative pain syndrome, and postoperative nausea and vomiting)

Endoscopic endonasal transclival removal of tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 140 patients)

Abstract Background Until recently, tumors of the clivus and the anterior region of the posterior cranial fossa were considered extremely difficult to access and often inoperable using standard transcranial approaches. With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. Methods From 2008 to the present time, the inpatient institution has operated on 140 patients with various tumors of the base of the skull, localized to the clivus and anterior region of the posterior cranial fossa (65 men and 75 women). The age of patients ranged from 3 to 74 years. Tumor distribution according to the histopathological features was as follows: chordomas, 103 (73.57%); meningiomas, 12 (8.57%); pituitary adenomas, 9 (6.43%); fibrous dysplasia, 4 (2.86%); cholesteatoma, 3 (2.14%); craniopharyngiomas, 2 (1.43%); plasmacytomas, 2 (1.43%); and other tumors (giant cell tumor, neurohypophyseal glioma, osteoma, carcinoid, chondroma), 5 (3.57%). The tumors had the following size distribution: giant (more than 60 mm), 35 (25%); large (35–59 mm), 83 (59.3%); medium (21–35 mm), 21 (15%); and small (less than 20 mm), 1 (0.7%). In 11 cases, intraoperative monitoring of the cranial nerves was performed (21 cranial nerves were identified). Results Upper, middle, and lower transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa. The chordoma cases were distributed as follows according to extent of removal: total removal, 68 (66.02%); subtotal removal, 25 (24.27%); and partial removal, 10 (9.71%). The adenomas of the pituitary gland were removed totally in 6 cases, subtotally in 1 case and partially in 2 cases. The meningiomas were removed totally in 1 case, subtotally in 5 cases, and partially in 5 cases, with less than 50% of the tumor removed in 1 case. Other tumors (cholesteatoma, craniopharyngioma, fibrous dysplasia, giant cell tumor, glioma of the neurohypophysis, osteoma, plasmacytoma, carcinoid, and chondroma) were removed totally in 9 cases and subtotally in 7 cases. Postoperative CSF leaks occurred in 9 cases (6.43%) and meningitis in 13 cases (9.29%). Oculomotor disorders developed in 19 patients (13.57%), 12 of which regressed during the period from 4 to 38 days after surgery, and 7 of which were permanent. In 2 cases, surgical treatment had a lethal outcome (1.43%). Conclusion The endoscopic endonasal transclival approach can be used to obtain access to the centrally located tumors of the posterior cranial fossa. It is an alternative to transcranial approaches in the surgical treatment of tumors of the clivus. The results of using this approach are comparable with the results of transcranial and transfacial approaches and, in some cases, surpass them in effectiveness. The extended endoscopic endonasal posterior (transclival) approach, considering its minimally invasive nature, allows fora radical and low-risk (in terms of postoperative complications and lethality) removal of various skull base tumors of central localization with the involvement and without the involvement of the clivus, which, until recently, were considered to be almost inoperable

Edizione Nazionale del Carteggio di L.A. Muratori, vol. 11, Carteggi con Cacciago .... Capilupi

Questo carteggio conferma, al pari degli altri volumi, la straordinaria capacit\ue0 dell\u2019erudito modenese di tessere una rete di contatti e scambi culturali che andava dagli angoli pi\uf9 remoti della Penisola alle grandi sedi della cultura europea. Tra i carteggi raccolti nel presente volume \u2013 in tutto cinquantasei \u2013 spiccano, per consistenza e interesse, quelli con il veneto Angelo Caloger\ue0, esponente di rilievo del giornalismo scientifico, il filosofo siciliano Tommaso Campailla, l\u2019erudito marchigiano Filippo Camerini, l\u2019abate Pietro Canneti e il geografo Giacomo Cantelli. Non mancano inoltre lettere che gettano luce sulla multiforme personalit\ue0 muratoriana, i cui interessi spaziavano dalla medicina (carteggio con P. Capilupi), alla pratica pastorale (Campi Cervelli), al diritto canonico (C.L. Calcagnini), ai molti volti della storia. Interessanti infine i contatti pi\uf9 o meno occasionali di quanti si rivolsero al modenese per ricevere consigli in materia di genealogia, educazione e linguistica

The oligonucleotides used for the preparation of the DNA libraries.

<p>The oligonucleotides used for the preparation of the DNA libraries.</p

Validation of the potentially somatic retroelement insertions.

<p>Black arrows show the primers. GP primers are complementary to the flanking sequences, RE primers are complementary to the retroelement sequence (RE).</p

The orientation of somatic L1 and Alu insertions relative to nearby genes.

<p>*—p-value based on Monte-Carlo test, 1000 permutations (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0117854#sec007" target="_blank">Materials and Methods</a> for details), NS—non-significant (p>0.05)</p><p>The orientation of somatic L1 and Alu insertions relative to nearby genes.</p

Number of the retroelement insertions detected within genes and promoters (for each library, predictions are derived from 1000 simulations of coordinates sample sets).

<p>Error bars show 1 SD. (A)—L1 in genes; (B)—L1 in promoters; (C)—Alu in genes; (D)—Alu in promoters.</p

The number of potentially somatic L1 and Alu insertions detected in different tissue samples and the data on their distribution in genome.

<p>The number of potentially somatic L1 and Alu insertions detected in different tissue samples and the data on their distribution in genome.</p

Retroelements flanking sequences library preparation.

<p>Small vertical arrows show the restriction sites. Horizontal arrows show PCR primers.</p