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

Laminoplasty versus Laminectomy in the Treatment of Primary Spinal Cord Tumors in Adult Patients: A Systematic Review and Meta-analysis of Observational Studies

The present systematic review and meta-analysis was conducted to compare the safety and efficacy of the two approaches for primary spinal cord tumors (PSCTs) in adult patients (laminoplasty [LP] vs. laminectomy [LE]). LE is one of the most common procedures for PSCTs. Despite advantages of LP, it is not yet widely used in the neurosurgical community worldwide. The efficacy of LP vs. LE remains controversial. Adult patients over 18 years of age with PSCT at the level of the cervical, thoracic, and lumbar spine were included in the study. A literature search was performed in MEDLINE via PubMed, EMBASE, The Cochrane Library, and Google Scholar up to December 2021. Operation time, hospital stay, complications, and incidence of postoperative spinal deformity (kyphosis or scoliosis were extracted. A total of seven retrospective observational studies with 540 patients were included. There were no significant differences between LP and LE group in operation time (p=0.25) and complications (p=0.48). The LE group showed larger postoperative spinal deformity rate than the LP group (odds ratio, 0.47; 95% confidence interval [CI], 0.27−0.84; p=0.01). The LP group had a shorter hospital stay (standardized mean differences, −0.68; 95% CI, −1.03 to −0.34; p=0.0001) than the LE group. Both LP and LE have comparable operative times and total complications in the treatment of PSCT. LP was superior to LE in hospital stay and postoperative spinal deformity rate. However, these findings are limited by the very low quality of the available evidence. Randomized controlled trials are needed for further comparison

Genes Suggest Ancestral Colour Polymorphisms Are Shared across Morphologically Cryptic Species in Arctic Bumblebees

email Suzanne orcd idCopyright: © 2015 Williams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

SARS-Cov2 acute and post-active infection in the context of autoimmune and chronic inflammatory diseases

International audienceThe clinical and immunological spectrum of acute and post-active COVID-19 syndrome overlaps with criteria used to characterize autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Indeed, following SARS-Cov2 infection, the innate immune response is altered with an initial delayed production of interferon type I (IFN-I), while the NF-kappa B and inflammasome pathways are activated. In lung and digestive tissues, an alternative and extrafollicular immune response against SARS-Cov2 takes place with, consequently, an altered humoral and memory T cell response leading to breakdown of tolerance with the emergence of autoantibodies. However, the risk of developing severe COVID-19 among SLE and RA patients did not exceed the general population except in those having pre-existing neutralizing autoantibodies against IFN-I. Treatment discontinuation rather than COVID-19 infection or vaccination increases the risk of developing flares. Last but not least, a limited number of case reports of individuals having developed SLE or RA following COVID-19 infection/vaccination have been reported. Altogether, the SARS-Cov2 pandemic represents an unique opportunity to investigate the dangerous interplay between the immune response against infectious agents and autoimmunity, and to better understand the triggering role of infection as a risk factor in autoimmune and chronic inflammatory disease development

Prevalence of lumbosacral transitional vertebra among 4816 consecutive patients with low back pain: A computed tomography, magnetic resonance imaging, and plain radiographic study with novel classification schema

Study Design: A retrospective single-center study. Background: The prevalence of the lumbosacral anomalies remains controversial. The existing classification to characterize these anomalies is more complex than necessary for clinical use. Purpose: To assessment of the prevalence of lumbosacral transitional vertebra (LSTV) in patients with low back pain and the development of clinically relevant classification to describe these anomalies. Materials and Methods: During the period from 2007 to 2017, all cases of LSTV were preoperatively verified, and classified according to Castellvi, as well as O'Driscoll. We then developed modifications of those classifications that are simpler, easier to remember, and clinically relevant. At the surgical level, this was assessed intervertebral disc and facet joint degeneration. Results: The prevalence of the LSTV was 8.1% (389/4816). The most common L5 transverse process anomaly type was fused, unilaterally or bilaterally (48%), to the sacrum and were O'Driscoll's III (40.1%) and IV (35.8%). The most common type of S1-2 disc was a lumbarized disc (75.9%), where the disc's anterior-posterior diameter was equal to the L5-S1 disc diameter. In most cases, neurological compression symptoms (85.5%) were verified to be due to spinal stenosis (41.5%) or herniated disc (39.5%). In the majority of patients without neural compression, the clinical symptoms were due to mechanical back pain (58.8%). Conclusions: LSTV is a fairly common pathology of the lumbosacral junction, occurring in 8.1% of the patients in our series (389 out of 4,816 cases). The most common types were Castellvi's type IIA (30.9%) and IIIA (34.9%) and were O'Driscoll's III (40.1%) and IV (35.8%)

Microvascular Anastomosis Training in Neurosurgery: A Review

Cerebrovascular diseases are among the most widespread diseases in the world, which largely determine the structure of morbidity and mortality rates. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Training in microvascular surgery became even more difficult with less case exposure and growth of the use of endovascular techniques. In this text we will briefly discuss the history of microvascular surgery, review current literature on simulation models with the emphasis on their merits and shortcomings, and describe the views and opinions on the future of the microvascular training in neurosurgery. In “dry” microsurgical training, various models created from artificial materials that simulate biological tissues are used. The next stage in training more experienced surgeons is to work with nonliving tissue models. Microvascular training using live models is considered to be the most relevant due to presence of the blood flow. Training on laboratory animals has high indicators of face and constructive validity. One of the future directions in the development of microsurgical techniques is the use of robotic systems. Robotic systems may play a role in teaching future generations of microsurgeons. Modern technologies allow access to highly accurate learning environments that are extremely similar to real environment. Additionally, assessment of microsurgical skills should become a fundamental part of the current evaluation of competence within a microneurosurgical training program. Such an assessment tool could be utilized to ensure a constant level of surgical competence within the recertification process. It is important that this evaluation be based on validated models