Invasive monitoring in presurgical evaluation of refractory temporal epilepsy

The article presents the results of the analysis of the efficiency of different types of invasive electrodes, implanted in 47 patients with refractory temporal epilepsy. The anamnestic data, a description of the semiology of seizures, MRI, the data of scalp and invasive monitoring are presented. A comparison of subdural, depth and sphenoidal electrodes is carried out on the basis of determination of the initial zone and the presence of complicationsВ статье приведены результаты анализа эффективности различных видов инвазивных электродов, имплантированных 47 пациентам с фармакорезистентной височной эпилепсией. Представлены анамнестические данные, описание семиологии приступов и МРТ-картины, данные скальпового и инвазивного мониторинга. Проведено сравнение субдуральных, глубинных и сфеноидальных электродов на основе установления локализации инициальной зоны приступа и наличия осложнений

Target effects of cytikoline on key elements of nervous tissue damage process

The main modern approach to pharmacological correction of pathobiochemical disorders in the damage of nervous tissue is the use of drugs with pleiotropic effects: neuroreparative, neuroprotective and the ability to modulate the mechanisms of neuroplasticity. The target effect on the key links in the processes of damage to the nervous tissue from the group of neuroprotectors is citicoline, an analog of the natural endogenous mononucleotide cytidine-5-diphosphocholine. The clinical use of this drug is justified by central pharmacological effects, so citicoline is recommended as a means of choice for the treatment of cerebrovascular diseases. Mechanisms for the development of citicoline effects have not been studied sufficiently and are considered primarily in the context of its effect on the synthesis of phospholipids in neuronal membranes and the participation of choline in neurochemical processes. A promising and topical direction is the study of receptor targets in the mechanisms of neuroprotective and neuroreparative effects of this drug.Основной современный подход к фармакологической коррекции патобиохимических нарушений при повреждении нервной ткани - применение лекарственных средств с плейотропными эффектами: нейрорепаративным, нейропротективным и возможностью модулировать механизмы нейропластичности. Целевым воздействием на ключевые звенья процессов повреждения нервной ткани различного генеза из группы нейропротекторов обладает препарат цитиколин — аналог естественного эндогенного мононуклеотида цитидин-5-дифосфохолина. Клиническое применение этого препарата оправдано центральными фармакологическими эффектами, поэтому цитиколин рекомендован, как средство выбора для лечения цереброваскулярных заболеваний. Механизмы развития эффектов цитиколина изучены недостаточно и рассматриваются преимущественно в рамках его влияния на синтез фосфолипидов в мембранах нейронов и участия холина в нейрохимических процессах. Перспективным и актуальным направлением является исследование рецепторных мишеней в механизмах нейропротекторного и нейрорепаративного эффектов этого препарата

Neuroprotective activity of citicoline in prophylactic injection in Experiment

Objective. To perform a comparative neurological assessment of neuroprotective activity of citicoline in a prophylactic and therapeutic injection on the model of focal brain ischemia in rats. Matherials and Methods. The study was performed on 51 male rats with weight 180-220 g. We studied the potential of preventative single injection and daily therapeutic injection of citicoline (2000 mg/kg) on the model of 60-minute intravasal occlusion of the left MCA Assessment of neurological deficit in all experimental groups was performed before ischemia and the next 5 days after using the 4-point Bederson scale and the McGraw Stroke Index scale with Ohno modifications. Results. Intravascular occlusion of the left MCA was followed by neurologic disorders of different severity in experimental animals of all groups. At the same time, daily (therapeutic) use of CDP-choline in the postischemic period was not followed by statistically significant improvement in neurological status in rats compared with control group. The most significant protective effect of citicoline, according to neurological test, was marked in cases with single prophylactic injection before ischemia. Conclusion. Prophylactic injection of citicoline possesses a pronounced neuroprotective activity in case of cerebral ischemia, which is manifested by significantly smaller number of cases with neurologic deficit and lethality of experimental animals in comparison with control group.Цель исследования. Провести сравнительную неврологическую оценку нейропротекторной активности цитиколина при профилактическом и лечебном введении на модели фокальной транзиторной ишемии головного мозга у крыс. Материалы и методы. Работа выполнена на 51 беспородных крысах-самцах, весом 180-220 гр. Исследовали эффективность в/б введения цитиколина (2000 мг/кг) при моделировании 60 минутной интравазальной окклюзии левой СМА при профилактическом однократном и ежедневном лечебном назначении. Оценку неврологического дефицита во всех экспериментальных группах осуществляли до ишемии и в последующие 5 суток с применением 4х бальной шкалы Бедерсона и шкалы оценки неврологических нарушений McGraw с модификациями Ohno. Результаты. Внутрисосудистая окклюзия левой СМА сопровождалась неврологическими нарушениями различной степени выраженности у экспериментальных животных всех групп. При этом, ежедневное (лечебное) назначение ЦДФ холина в постишемическом периоде не сопровождалось статистически значимым улучшением неврологического статуса у крыс в сравнении с контрольной группой. Наиболее существенное защитное действие цитиколина по данным неврологического тестирования отмечалось при его однократном профилактическом введении до ишемии. Заключение. Цитиколин при профилактическом введении обладает выраженной нейропротекторной активностью при ишемии головного мозга, что проявляется значительно меньшим неврологическим дефицитом и летальностью экспериментальных животных в сравнении с контрольной группой

The significance of lymphocytic infiltration in the development of schwannomas relapses

The purpose of the study – assess the impact of lymphocytic infiltration on the development of schwannomas relapses.Цель исследования – оценить влияние лимфоцитарной инфильтрации на развитие рецидивов шванном

Topographic anatomy of two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches: A comparative analysis of neurosurgical options

Aim – to measure and compare the vertical and horizontal angles of attack on different intracranial surgical targets provided by the transzygomatic, modified orbitozygomatic and classic two-piece orbitozygomatic approaches, to determine the most optimal approaches to different surgical targets. Material and methods. The study was conducted on 8 sides of en bloc specimens of human head and neck. The marking was performed with BrainLAB Kolibri navigational station (Germany) to highlight the surgical landmarks and measure the angles. The dissection was started macroscopically with standard instruments and photographic fixation of every stage of the approach. The craniotomy was performed with Stryker high speed drill (USA). After that, the microscopic stage was carried out with the ZEISS OPMI Vario/S88 surgical microscope (Germany). On each side, the following steps were completed: soft tissues dissection, cutting the zygomatic arch, fronto-temporal craniotomy, orbitozygomatic osteotomy, opening of the dura mater and dissection of structures of the cranial base, measurement of angles of attack with their apex located on skull base structures Results. The angles of attack on different intracranial surgical targets were measured and compared for two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches. Conclusion. The two-piece orbitozygomatic craniotomy is the most universal and optimal to approach the basilar artery bifurcation and lesions located in both anterior and middle cranial fossae. However, to minimize the surgical trauma and the risks of complications when exposing exclusively anterior cranial fossa, the modified orbitozygomatic approach is more adequate. When the lesion is small and located exclusively in middle cranial fossa, performing the transzygomatic approach is recommended

Механизм развития посттравматических глиом

Gliomas are the most common primary tumors of the central nervous system. Their aggressive form – glioblastomas is characterized by an unfavorable prognosis and a high frequency of relapses. It is believed that prior traumatic brain injury is one of the possible factors for the subsequent development of glial brain tumors. Several authors have proposed several criteria for establishing a possible causal relationship between traumatic brain injury and gliomas. However, the actual role of antecedent brain injury in the pathogenesis of this tumor type is still a matter of debate. It has been suggested that traumatic injuries cause an active and prolonged inflammatory process, while disrupting the permeability of the blood-brain barrier, which leads to exposure of the brain tissue to carcinogenic (toxic) substances, various growth factors or cells of the immune system circulating in the bloodstream, which ultimately can lead to malignant transformation of glial cells. One of the evidence for this hypothesis is supported by reports of meningiomas located adjacent to posttraumatic meninges and cerebral scars. In this paper, we will try to elucidate the potential relationship between traumatic brain injury and the formation of glial brain tumors.Глиомы являются наиболее распространенными первичными опухолями центральной нервной системы. Их агрессивная форма – глиобластомы – характеризуются неблагоприятным прогнозом и высокой частотой рецидивов. Считается, что предшествующая черепно-мозговая травма служит одним из возможных факторов последующего развития глиальных опухолей головного мозга. Ряд авторов предложили критерии установления возможной причинно-следственной связи между черепно-мозговой травмой и глиомами. Однако фактическая роль предшествующей травмы мозга в патогенезе данного типа опухолей все еще остается предметом дискуссий. Было высказано предположение, что травматические повреждения вызывают активный и продолжительный воспалительный процесс. При этом нарушается проницаемость гематоэнцефалического барьера, что приводит к воздействию на ткани головного мозга канцерогенных (токсичных) веществ, различных факторов роста или клеток иммунной системы, циркулирующих в кровотоке. В результате может возникнуть злокачественная трансформация глиальных клеток. Эта гипотеза подтверждается сообщениями о менингиомах головного мозга, расположенных рядом с посттравматическими оболочечно-мозговыми рубцами. В данной работе мы попытаемся выяснить потенциальную связь между черепно-мозговой травмой и формированием глиальных опухолей головного мозга

Deep brain stimulation of the anterior nucleus of the thalamus in drug-resistant epilepsy in the MORE multicenter patient registry

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background and objectives: The efficacy of deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) in patients with drug-resistant epilepsy (DRE) was demonstrated in the double-blind Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy randomized controlled trial. The Medtronic Registry for Epilepsy (MORE) aims to understand the safety and longer-term effectiveness of ANT DBS therapy in routine clinical practice. Methods: MORE is an observational registry collecting prospective and retrospective clinical data. Participants were at least 18 years old, with focal DRE recruited across 25 centers from 13 countries. They were followed for at least 2 years in terms of seizure frequency (SF), responder rate (RR), health-related quality of life (Quality of Life in Epilepsy Inventory 31), depression, and safety outcomes. Results: Of the 191 patients recruited, 170 (mean [SD] age of 35.6 [10.7] years, 43% female) were implanted with DBS therapy and met all eligibility criteria. At baseline, 38% of patients reported cognitive impairment. The median monthly SF decreased by 33.1% from 15.8 at baseline to 8.8 at 2 years (p 10 implantations) had 42.8% reduction in median monthly SF by 2 years in comparison with 25.8% in low-volume center. In patients with cognitive impairment, the reduction in median monthly SF was 26.0% by 2 years compared with 36.1% in patients without cognitive impairment. The most frequently reported adverse events were changes (e.g., increased frequency/severity) in seizure (16%), memory impairment (patient-reported complaint, 15%), depressive mood (patient-reported complaint, 13%), and epilepsy (12%). One definite sudden unexpected death in epilepsy case was reported. Discussion: The MORE registry supports the effectiveness and safety of ANT DBS therapy in a real-world setting in the 2 years following implantation. Classification of evidence: This study provides Class IV evidence that ANT DBS reduces the frequency of seizures in patients with drug-resistant focal epilepsy.The MORE registry was sponsored and funded by Medtronic, plc.info:eu-repo/semantics/publishedVersio

Successful Endovascular Treatment for Recanalized Post-Traumatic Carotid-Cavernous Fistula

Carotid-cavernous fistulas (CCFs) are spontaneous or acquired communications between the internal carotid artery (ICA) and the cavernous sinus, which can be classified as direct or indirect. Direct fistulas between the ICA and the cavernous sinus can arise from injury, rupture of intracavernous carotid aneurysm, collagen deficiency syndrome, artery dissection, fibromuscular dysplasia, and direct surgical trauma. The symptoms caused by CCF are related to their size, duration, location, the direction of venous outflow, and the presence of arterial and venous collaterals. The goal of treatment for direct CCFs is to close the defect between the ICA and the cavernous sinus while maintaining the patency of the ICA. This goal can be achieved either by transarterial fistula occlusion using a removable balloon, transarterial or transvenous occlusion of the ipsilateral cavernous sinus with coils or other embolic material, or by implanting a covered stent in the fistula area. The choice of a method for CCF treatment remains relevant. The paper describes a clinical case of successful endovascular treatment for post-traumatic recanalized CCF in a patient with obvious ophthalmic manifestations as pulsating exophthalmos, conjunctival chemosis, and ischemic optic neuropathy of the right eye. Previously, the patient had undergone endovascular CCF embolization with coils and ICA reconstruction with flow diverting stents. Fistula embolization was performed with coils via transvenous access. In the opinion of the authors, the use of venous access in this case allowed them to perform total occlusion of the recanalized fistula and to achieve good angiographic and clinical results in the long-term period

MSCT-semiotics of vertebrae in patients with cervical spine stenosis

Introduction The number of surgical interventions on the cervical spine for stenosis has been constantly increasing. This fact proves that there is a need for careful preoperative preparation that would consider the complexity of the intervention and the age of the patients. Purpose To substantiate the need to include the MSCT data processing algorithm of bone tissue density of vertebral bodies and arches to assess their quality for planning osteoplastic decompressive laminoplasty in patients with cervical spine stenosis due to degenerative changes. Material and methods This single-center retrospective study investigated qualitative and quantitative characteristics of the spine with radiography and multislice computed tomography (MSCT) in 82 patients with degenerative diseases of the cervical spine and associated spinal canal stenosis (CSS). Results and discussion The data obtained indicate a tendency for the total density of the cervical vertebrae to increase from C3 to C5 and to decrease caudally, with minimal density in C7 without signs of osteoporosis. A similar trend is characteristic of trabecular bone. The density of the osteon layer of the vertebral arch cortex differs significantly from the density of the outer and inner plates. The total density of the compact layer of the vertebral arch cortex exceeds 785.15 ± 38.4 HU. Conclusion The data obtained justify the need to include the study of the density of vertebral bodies, vertebral arches, and its thickness in the MSCT data processing algorithm to develop a plan for surgical intervention in patients with cervical spine stenosis in order to obtain objective data on the quality of the bone