Total spondylectomy in surgical treatment of primary and localized secondary tumors of the thoracic and lumbar spine

Effective treatment of primary and localized secondary tumors of thoracic and lumbar spine is one of complex problem in spinal surgery. Lack of surgical radicalism with leaving tumor fragment in situ due to problems of differentiation tumor and non-tumor tissue, absence of clear dissection plane are the main causes of high rate of local neoplastic recurrence, up to 54–89% according to literature data. Wide and marginal tumor resection with obeying principles of oncologic barriers and compartment is the only method of surgical prophylaxis of local recurrence. Development of total spondylectomy technique in surgical treatment of primary and localized secondary tumors of thoracic and lumbar spine is the way to achieve maximal control of aggressive spine tumors growth

Тотальна спондилектомія в хірургічному лікуванні первинних та обмежених вторинних пухлин грудного та поперекового відділів хребта

Effective treatment of primary and localized secondary tumors of thoracic and lumbar spine is one of complex problem in spinal surgery. Lack of surgical radicalism with leaving tumor fragment in situ due to problems of differentiation tumor and non-tumor tissue, absence of clear dissection plane are the main causes of high rate of local neoplastic recurrence, up to 54–89% according to literature data. Wide and marginal tumor resection with obeying principles of oncologic barriers and compartment is the only method of surgical prophylaxis of local recurrence. Development of total spondylectomy technique in surgical treatment of primary and localized secondary tumors of thoracic and lumbar spine is the way to achieve maximal control of aggressive spine tumors growth.Проблема эффективного лечения первичных и вторичных опухолей грудного и поясничного отделов позвоночника является одной из сложных в cпинальной нейрохирургии. Недостаточная радикальность хирургического вмешательства, оставление участков ткани опухоли вследствие трудности дифференцирования ее от интактных тканей, отсутствие четкой плоскости диссекции являются основными факторами высокой частоты возникновения локальных рецидивов, достигающей, по данным литературы, 54–89%. Выполнение широкой и краевой резекции новообразования с соблюдением принципов онкологических барьеров и пространства является единственным способом хирургической профилактики локальных рецидивов. Тотальная спондилэктомия при первичных и ограниченных вторичных опухолях грудного и поясничного отделов позвоночника позволяет достичь максимального контроля роста агрессивных новообразований.Проблема ефективного лікування первинних і вторинних пухлин грудного та поперекового відділів хребта є однією з складних у cпінальній нейрохірургії. Недостатня радикальність хірургічного втручання з залишенням ділянок пухлини внаслідок неможливості її відмежування від неуражених тканин, відсутність чіткої площини дисекції є основними чинниками високої частоти виникнення локальних рецидивів, що становить, за даними літератури, 54–89%. Виконання широкої та крайової резекції новоутворення з дотриманням принципів онкологічних бар’єрів та простору є єдиним способом хірургічної профілактики локальних рецидивів. Тотальна спондилектомія з приводу первинних та обмежених вторинних пухлин грудного та поперекового відділів хребта дозволяє досягти максимального контролю росту агресивних новоутворень

Determination of inflammatory mediator levels in cerebrospinal fluid during the formation of cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage

Introduction. Delayed cerebral ischemia (DCI) and cerebral vasospasm (CV) lead to poor outcomes in patients after aneurysmal subarachnoid hemorrhage (aSAH). The pathophysiology of these complications is not fully understood, preventing the adoption of a single definition. Reliable diagnostic tests and effective evidence-based treatment are lacking. Objective: to determine the relationship between the concentration of interleukin-6 (IL-6), IL-10, IL-17, tumor necrosis factor-α (TNF-α) in cerebrospinal fluid and formation of delayed complications of subarachnoid hemorrhage. Materials and methods. The study involved 45 patients with aSAH who were treated in Kharkiv Regional Hospital (18 men and 27 women aged 32 to 73 years (mean age ‒ 45.9±8.5 years). The control group consisted of 20 healthy individuals (8 men and 12 women aged from 32 to 73 years (mean age - 59.2±10.6 years). The occurrence of DCI or CV was recorded. The level of IL-6, IL-10, IL-17 and TNF-α in the cerebrospinal fluid (CSF) was measured in all subjects of the study using enzyme-linked immunosorbent assay. Results. Levels of IL-6, TNF-α, IL-17, and IL-10 in the CSF of patients with aSAH were higher than in control subjects. In patients with CV, the values of IL-6, IL-17 and TNF-α in CSF exceeded those of patients without CV. The concentration of IL-6 and TNF-α was also increased in the cerebrospinal fluid of patients with DCI. Conclusions. The obtained results indicate that IL-6 and TNF-α in CSF may be early markers for predicting vasospasm and DCI on the 3rd day after subarachnoid hemorrhage before clinical onset. The content of IL-17 correlates with the formation of cerebral vasospasm, but there is no connection between its level in the CSF and DCI. The concentration of IL-10 in the CSF on the 3rd day after aSAH had no prognostic value either for CV or for DCI formation

Own experience of using holographic neuronavigation using an augmented reality helmet in neurosurgery

Objective: to optimize surgical access to intracranial lesions (tumors, arteriovenous malformations, cysts, etc.) by using a holographic neuronavigation system with augmented reality helmet. Materials and methods: The study included thirty-four patients who underwent cerebral neurosurgical interventions. Creation and clinical use of mixed reality neuronavigation (MRN) system holograms was possible in all cases, which allowed accurate localization of lesions. The additional time required for synchronizing the MRN system with the clinical environment was estimated, which decreased with the number of MRN system uses. Operators evaluated the effectiveness of the technology and in most cases provided positive evaluations after use. Results: A semi-automatic MRN recording system on HoloLens smart glasses has been developed and tested for accuracy and performance. 34 patients with intracranial lesions were prospectively included in the study. Three-dimensional holograms of lesions, markers, and surrounding anatomical landmarks based on multimodal imaging were generated for each patient and then imported into the MRN system in AR helmet. After point recording, holograms were projected onto the patient’s head and observed through the AR helmet during the planning and conducting of surgical interventions. Conclusions: In this small pilot study, the authors found that mixed reality neuronavigation system MRN can be applied in the workflow of a neurosurgical operating room and is a possible method of preoperative identification of lesion boundaries for surgical access planning. Future studies are needed to identify strategies to improve and optimize the accuracy of MRN system