Применение транскраниальной магнитной стимуляции в нейрохирургии

Transcranial magnetic stimulation (TMS) is a relatively new diagnostic and therapeutic method. Its widespread introduction into neurosurgical practice began in 2009. The method is used for non-invasive detection of eloquent brain areas. The combination with tractography facilitates the projection of pathways. The review summarizes the main results of TMS in the planning of neurosurgical interventions. We described the principle of method, analyzed its benefi ts and shortcomings, compared it with direct cortical stimulation which is a “gold standart” in detection of eloquent brain centers.Транскраниальная магнитная стимуляция (ТМС) является относительно новым диагностическим и лечебным методом. Ее широкое внедрение в нейрохирургическую практику началось с 2009 года. Метод применяют для неинвазивного обнаружения функционально значимых центров головного мозга. Сочетание с трактографией облегчает построение проводящих путей. В обзоре обобщены основные результаты применения ТМС при планировании нейрохирургических вмешательств. Рассмотрены принцип метода, его преимущества и недостатки, приведено сравнение с результатами прямой корковой стимуляции, являющейся «золотым стандартом» при обнаружении функционально значимых центров головного мозга

Роботы в краниальной нейрохирургии, эволюция за 35 лет

We reviewed the experience of robotic devices in cranial neurosurgery for 35 years. The brief history is represented, prerequisites for robotics development are specified. The most popular devices are listed, which are used for surgical instruments positioning and remote manipulations. We pointed key robotic features, main results of their application, showed advantages, shortcomings and ways to resolve some problems. The accurateness of robotic systems is shown in comparison with frame-based stereotactic surgery. The main trends in robotic development in the future are described as well.В обзоре литературы описан 35-летний опыт работы с роботами в краниальной нейрохирургии. Представлен краткий исторический очерк и указаны предпосылки развития робототехники. Перечислены наиболее известные устройства, используемые для позиционирования хирургических инструментов и дистанционных манипуляций. Указаны ключевые особенности роботов, основные результаты их применения, представлены преимущества, недостатки и пути решения некоторых проблем. Показана точность роботизированных систем в сравнении с рамным стереотаксисом. В завершение приведены основные тенденции роботостроения в будущем

The Heavy Photon Search Test Detector

The Heavy Photon Search (HPS), an experiment to search for a hidden sector photon in fixed target electroproduction, is preparing for installation at the Thomas Jefferson National Accelerator Facility (JLab) in the Fall of 2014. As the first stage of this project, the HPS Test Run apparatus was constructed and operated in 2012 to demonstrate the experiment׳s technical feasibility and to confirm that the trigger rates and occupancies are as expected. This paper describes the HPS Test Run apparatus and readout electronics and its performance. In this setting, a heavy photon can be identified as a narrow peak in the e+ e− invariant mass spectrum above the trident background or as a narrow invariant mass peak with a decay vertex displaced from the production target, so charged particle tracking and vertexing are needed for its detection. In the HPS Test Run, charged particles are measured with a compact forward silicon microstrip tracker inside a dipole magnet. Electromagnetic showers are detected in a PbW04 crystal calorimeter situated behind the magnet, and are used to trigger the experiment and identify electrons and positrons. Both detectors are placed close to the beam line and split top-bottom. This arrangement provides sensitivity to low-mass heavy photons, allows clear passage of the unscattered beam, and avoids the spray of degraded electrons coming from the target. The discrimination between prompt and displaced e+ e− pairs requires the first layer of silicon sensors be placed only 10 cm downstream of the target. The expected signal is small, and the trident background huge, so the experiment requires very large statistics. Accordingly, the HPS Test Run utilizes high-rate readout and data acquisition electronics and a fast trigger to exploit the essentially 100% duty cycle of the CEBAF accelerator at JLab

Assessing trigeminal microstructure changes in patients with classical trigeminal neuralgia

Introduction. The crucial role of neuro-vascular conflict (NVC) in trigeminal neuralgia (TN) is getting increasingly challenged. Microstructural changes can be assessed using fractional anisotropy (FA) in diffusion tensor images (DTI). Objective. To evaluate usefulness of FA in brain MRI with DTI for TN lateralization assessment. Materials and methods. The study included 51 patients with classical TN divided into two groups: neurosurgical intervention free, post radiofrequency ablation (RFA), and a control group (patients without facial pain). All the patients were tested for NVC with FIESTA (Fast Imaging Employing Steady State Acquisition) brain MRI at 3Т. Difference in thickness of trigeminal roots on the intact and symptomatic sides was assessed for each group. The findings were compared to those in the control group. The MRI protocol was supplemented with DTI. The FA difference in thickness of the intact and symptomatic roots (∆FA) was calculated for each study group to assess microstructural root changes. The results were compared to those in the control group. Results. In trigeminal root DTIs, ∆FA over 0.075 [0.029; 0.146] is statistically significant to establish NVC-associated microstructural changes on the symptomatic side in patients without any past surgeries (p = 0,030). In patients with a history of trigeminal ganglion RFA, statistically significant (p = 0.026) thinned symptomatic trigeminal root (difference in thickness of trigeminal roots over 0.45 cm [0.4; 0.6]) was found as compared to that of the control patients. Conclusion. FA may be used as a quantitative demyelination biomarker in clinical TN. Trigeminal ganglion RFA leads to hypotrophy throughout the trigeminal nerve root

Роль факторов риска при хирургическом лечении геморрагического инсульта

AIM OF STUDY To identify risk factors for adverse outcomes of surgical treatment of patients with HS.MATERIAL AND METHODS A retrospective analysis of the results of surgical treatment of 500 patients operated on at the N.V. Sklifosovsky Institute from 1997 to 2020 for hypertensive intracerebral hematomas. The mean age of the patients was 53.1±12.2 years. There were 335 (67%) men and 165 (33%) women.The level of consciousness before the operation was clear in 176 (35.2%), stupor (11–14 score, GCS) — in 258 (53.6%), sopor (score 9–10, GCS) — in 38 (7.6 %), moderate coma (7–8 score, GCS) — in 10 (2%) patients, deep coma (score 6) — in 7 (1.4%) patients. ICHs were lobar in 218 (43.6%) patients, lateral in 212 (42.4%) patients, thalamic in 10 (2%) patients, mixed in 10 (2%) patients, cerebellar in 50 (10% ) patients. The average volume of ICH was 46.5±25.1 cm3, supratentorial ICH – 49.6±24.5 cm3 (from 4 to 147 cm3), subtentorial — 18.7±6.4 cm3 (from 5 to 36 cm3). The average duration of the surgical intervention was 3.3±2.6 days. The following types of operations were performed: open removal of the ICH in 271 (54.2%) patients, puncture aspiration and local fibrinolysis of the ICH in 98 (19.6%) cases, endoscopic aspiration of the ICG in 131 (26.2%) patients.RESULTS The risk factors for lethal outcome in HT surgery are the age of patients older than 50 years (χ2=13.9, p<0.04), the volume of cerebral hemispheres more than 50 cm3 (χ2=7.8, p<0.01), the total volume of ICH and perifocal edema more than 100 cm3 (χ2=9.1, p<0.01), transverse dislocation of the median structures of the brain more than 5 mm (χ2=32.2, p<0.0001), axial dislocation of the brain (χ2=16 ,1, p<0.02), BP before surgery higher than 160 mm Hg (χ2=21.9, p<0.002), presence of IVH (χ2=36.9, p<0.00001), AOH (χ2=28.0, p<0.0001), surgery time — the first day after hemorrhage (χ2=64.4, p<0.00001), residual volume of ICH after surgery more than 15 cm3 (χ2=4.0, p<0.05) and recurrence of ICH (χ2=33.1, p<0.00001). The outcomes correlate with the severity of the patient’s condition before surgery (R=0.38, p<0.00001), and the risk factor for death is the depression of consciousness to deep stupor and below (χ2=97.2, p<0.00001).CONCLUSION Assessment of risk factors can help clarify the prognosis of the outcomes of surgical treatment and optimize the treatment tactics of patients.ЦЕЛЬ ИССЛЕДОВАНИЯ Выявление факторов риска неблагоприятных исходов хирургического лечения больных с геморрагическим инсультом (ГИ).МАТЕРИАЛ И МЕТОДЫ Проведен ретроспективный анализ результатов хирургического лечения 500 пациентов, оперированных в НИИ СП им. Н.В. Склифосовского с 1997 по 2020 год по поводу гипертензивных внутримозговых гематом (ВМГ). Средний возраст больных составил 53,1±12,2 года. Мужчин — 335 (67%), женщин — 165 (33%). Уровень сознания до операции соответствовал ясному у 176 (35,2%), оглушению (11–14 баллов по шкале комы Глазго (ШКГ)) — у 258 (53,6%), сопору (9–10 баллов по ШКГ) — у 38 (7,6%), умеренной коме (7–8 баллов по ШКГ) — у 10 (2%), глубокой коме (6 баллов по ШКГ) — у 7 больных (1,4%). ВМГ были лобарными — у 218 пациентов (43,6%), латеральными — у 212 (42,4%), таламическими — у 10 (2%), смешанными — у 10 (2%), мозжечковыми — у 50 (10%). Средний объем ВМГ составил 46,5±25,1 см3, супратенториальных ВМГ — 49,6±24,5 см3 (от 4 до 147 см3), субтенториальных — 18,7±6,4 см3 (от 5 до 36 см3). Средний срок проведения хирургического вмешательства составил 3,3±2,6 суток. Были проведены следующие виды операций: открытое удаление ВМГ — у 271 пациента (54,2%), пункционная аспирация и локальный фибринолиз ВМГ — у 98 (19,6%), эндоскопическая аспирация ВМГ — у 131 больного (26,2%).РЕЗУЛЬТАТЫ Факторами риска смертельного исхода в хирургии ГИ являются возраст больных старше 50 лет (χ2=13,9, p<0,04), объем ВМГ больших полушарий более 50 см3 (χ2=7,8, p<0,01), суммарный объем ВМГ и перифокального отека более 100 см3 (χ2=9,1, p<0,01), поперечная дислокация срединных структур мозга более 5 мм (χ2=32,2, p<0,0001), аксиальная дислокация мозга (χ2=16,1, p<0,02), систолическое артериальное давление до операции более 160 мм рт.ст. (χ2=21,9, p<0,002), наличие внутрижелудочкового кровоизлияния (χ2=36,9, p<0,00001), открытой окклюзионной гидроцефалии (χ2=28,0, p<0,0001), срок операции — первые сутки после кровоизлияния (χ2=64,4, p<0,00001), остаточный объем ВМГ после операции более 15 см3 (χ2= 4,0, p<0,05) и рецидив ВМГ (χ2=33,1, p<0,00001). Исходы коррелируют с тяжестью состояния больных перед операцией (R=0,38, p<0,00001), а фактором риска смертельного исхода является угнетение сознания до глубокого оглушения и ниже (χ2=97,2, p<0,00001).ЗАКЛЮЧЕНИЕ Оценка факторов риска может послужить уточнению прогноза исходов хирургического лечения и оптимизации лечебной тактики

Эндоскопическое удаление травматических внутримозговых гематом в остром периоде

ABSTRACT Nowadays surgical treatment of patients with traumatic intracranial hematoma (TICH) and injuries of the brain is a very actual problem in neurosurgery.The purpose of this work was to assess of the feasibility and safety of minimally invasive endoscopic removal of TICH.MATERIAL AND METHODS In the period of 2010–2019, 2734 operations were performed on patients with traumatic brain injury in the Sklifosovsky Research Institute. There were 334 patients with TICH and the CC/BC foci, that made 12.2% of all patients. The median of hematoma volume, that did not cause a loss of consciousness was 48 cm2, and in most of the patients the hematoma volume ranged 30–35 cm2. Local fibrinolysis of TICH was performed in 14 patients with the hematoma volume of 30–50 cm2 without brain dislocation and not causing the consciousness depression more severe than sopor.Endoscopic removal of TICH was performed in 4 men at mean age of 54.8 years within 18–36 hours after trauma. Three patients had depression of consciousness to obtundation (14 by Glasgow Outcome Scale (GCS)), and one patient was in clear consciousness. The volume of the dense part of the contusion foci in the pole-basal regions of the frontal and temporal lobes was 24–40 cm3.RESULTS Among patients with TICH operated on by using the traditional technique, postoperative lethality was 13%, good outcomes were seen in 41%, and 46% had neurological disorders of varying severity. While treating the patients with TICH by using the local fibrinolysis method, 1 patient died after surgery, a good outcome was seen in 8 of 14 patients, and neurological disorders persisted in 3 patients in the postoperative period.Radicality of surgery in patients operated on by using endoscopic technique averaged 76% ranging from 41% to 91%. There were no complications during surgery nor in post-operative period. Patients were discharged from hospital after 8-21 days.ВВЕДЕНИЕ Хирургическое лечение больных с травматическими внутримозговыми гематомами (ТВМГ) и ушибами головного мозга (УГМ) при помощи современных технологий и мини-инвазивной хирургии является актуальной проблемой нейрохирургии.ЦЕЛЬ Уточнение возможности и безопасности мини-инвазивного эндоскопического удаления ТВМГ.МАТЕРИАЛ И МЕТОДЫ В период 2010–2019 годов в НИИ СП им. Н.В. Склифосовского проведено хирургическое лечение 2734 пострадавшим с черепно-мозговой травмой. Пациентов с ТВМГ и очагами УГМ было 334, что составило 12,2% от всех оперированных. Медиана объема гематомы, при котором у пациентов не было нарушено сознание, составила 48 см3, и у большинства пострадавших объем гематомы находился в пределах 30–50 см3. Локальный фибринолиз ТВМГ был проведен у 14 пострадавших с объемом повреждения от 30 до 50 см3, не вызывающим грубой дислокации головного мозга, а клинически не сопровождающимся угнетением сознания глубже сопора.Эндоскопическое удаление ТВМГ было выполнено у 4 пострадавших — мужчин, средний возраст 54,8 года, в срок 18–36 часов после травмы. У 3 пациентов было угнетение сознания до оглушения (14 баллов по шкале комы Глазго (GCS)), а у одного больного сознание было ясным. Объем плотной части очагов ушиба в полюсно-базальных отделах лобных и височных долей составлял 24–40 см3.РЕЗУЛЬТАТЫ Среди пациентов с ТВМГ, оперированных традиционным способом, послеоперационная летальность составила 13%, хорошие исходы были у 41%, а у 46% были неврологические расстройства различной степени выраженности. При лечении больных с ТВМГ методом локального фибринолиза после операции умер 1 больной, хороший исход был у 8 пациентов из 14, а у 3 пациентов в послеоперационном периоде сохранялись неврологические нарушения.Радикальность операций у пострадавших, оперированных эндоскопическим методом, составила в среднем 76% (варьировала от 41 до 91%). Осложнений во время операций и в послеоперационном периоде не было. Пациенты выписаны в сроки от 8 до 21 суток

Beam-target helicity asymmetry for γ→n→→π−p in the N*resonance region

We report the first beam-target double-polarization asymmetries in the γ þ nðpÞ → π− þ pðpÞ reaction spanning the nucleon resonance region from invariant mass W ¼ 1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN* resonance photocouplings

The Heavy Photon Search test detector

The Heavy Photon Search (HPS), an experiment to search for a hidden sector photon in fixed target electroproduction, is preparing for installation at the Thomas Jefferson National Accelerator Facility (JLab) in the Fall of 2014. As the first stage of this project, the HPS Test Run apparatus was constructed and operated in 2012 to demonstrate the experiment׳s technical feasibility and to confirm that the trigger rates and occupancies are as expected. This paper describes the HPS Test Run apparatus and readout electronics and its performance. In this setting, a heavy photon can be identified as a narrow peak in the e+e− invariant mass spectrum above the trident background or as a narrow invariant mass peak with a decay vertex displaced from the production target, so charged particle tracking and vertexing are needed for its detection. In the HPS Test Run, charged particles are measured with a compact forward silicon microstrip tracker inside a dipole magnet. Electromagnetic showers are detected in a PbW04 crystal calorimeter situated behind the magnet, and are used to trigger the experiment and identify electrons and positrons. Both detectors are placed close to the beam line and split top-bottom. This arrangement provides sensitivity to low-mass heavy photons, allows clear passage of the unscattered beam, and avoids the spray of degraded electrons coming from the target. The discrimination between prompt and displaced e+e− pairs requires the first layer of silicon sensors be placed only 10 cm downstream of the target. The expected signal is small, and the trident background huge, so the experiment requires very large statistics. Accordingly, the HPS Test Run utilizes high-rate readout and data acquisition electronics and a fast trigger to exploit the essentially 100% duty cycle of the CEBAF accelerator at JLab

A comparison of forward and backward pp pair knockout in 3He(e,e'pp)n

Measuring nucleon-nucleon Short Range Correlations (SRC) has been a goal of the nuclear physics community for many years. They are an important part of the nuclear wavefunction, accounting for almost all of the high-momentum strength. They are closely related to the EMC effect. While their overall probability has been measured, measuring their momentum distributions is more difficult. In order to determine the best configuration for studying SRC momentum distributions, we measured the $^3$He$(e,e'pp)n$ reaction, looking at events with high momentum protons ($p_p > 0.35$ GeV/c) and a low momentum neutron ($p_n< 0.2$ GeV/c). We examined two angular configurations: either both protons emitted forward or one proton emitted forward and one backward (with respect to the momentum transfer, $\vec q$). The measured relative momentum distribution of the events with one forward and one backward proton was much closer to the calculated initial-state $pp$ relative momentum distribution, indicating that this is the preferred configuration for measuring SRC.Comment: 8 pages, 9 figures, submitted to Phys Rev C. Version 2 incorporates minor corrections in response to referee comment