The motivation for the present study was the need to develop methods of urgent intraoperative biopsy during surgery for removal of intracranial tumors. Based on the experience of previous joint work of GPI RAS and N.N. Burdenko National Medical Research Center of Neurosurgery to introduce fluorescence spectroscopy methods into clinical practice, an approach combining various optical-spectral techniques, such as autofluorescence spectroscopy, fluorescence of 5-ALA induced protoporphyrin IX, diffuse reflection of broadband light, which can be used to determine hemoglobin concentration in tissues and their optical density, Raman spectroscopy, which is a spectroscopic method that allows detection of various molecules in tissues by vibrations of individual characteristic molecular bonds. Such a variety of optical and spectral characteristics makes it difficult for the surgeon to analyze them directly during surgery, as it is usually realized in the case of fluorescence methods – tumor tissue can be distinguished from normal with a certain degree of certainty by fluorescence intensity exceeding a threshold value. In case the number of parameters exceeds a couple of dozens, it is necessary to use machine learning algorithms to build a intraoperative decision support system for the surgeon. This paper presents research in this direction. Our earlier statistical analysis of the optical-spectral features allowed identifying statistically significant spectral ranges for analysis of diagnostically important tissue components. Studies of dimensionality reduction techniques of the optical-spectral feature vector and methods of clustering of the studied samples also allowed us to approach the implementation of the automatic classification method. Importantly, the classification task can be used in two applications – to differentiate between different tumors and to differentiate between different parts of the same (center, perifocal zone, normal) tumor. This paper presents the results of our research in the first direction. We investigated the combination of several methods and showed the possibility of differentiating glial and meningeal tumors based on the proposed optical-spectral analysis method.
Traumatic brain injury (TBI) is a frequently encountered form of injury that can have lifelong implications. Despite advances in prevention, diagnosis, monitoring, and treatment, the degree of recovery can vary widely between patients. Much of this is explained by differences in severity of impact and patient-specific comorbidities; however, even among nearly identical patients, stark disparities can arise. Researchers have looked to genetics in recent years as a means of explaining this phenomenon. It has been hypothesized that individual genetic factors can influence initial inflammatory responses, recovery mechanisms, and overall prognoses. In this review, we focus on cytokine polymorphisms, mitochondrial DNA (mtDNA) haplotypes, immune cells, and gene therapy given their associated influx of novel research and magnitude of potential. This discussion is prefaced by a thorough background on TBI pathophysiology to better understand where each mechanism fits within the disease process. Cytokine polymorphisms causing unfavorable regulation of genes encoding IL-1β, IL-RA, and TNF-α have been linked to poor TBI outcomes like disability and death. mtDNA haplotype H has been correlated with deleterious effects on TBI recovery time, whereas haplotypes K, T, and J have been depicted as protective with faster recovery times. Immune cell genetics such as microglial differentially expressed genes (DEGs), monocyte receptor genes, and regulatory factors can be both detrimental and beneficial to TBI recovery. Gene therapy in the form of gene modification, inactivation, and editing show promise in improving post-TBI memory, cognition, and neuromotor function. Limitations of this study include a large proportion of cited literature being focused on pre-clinical murine models. Nevertheless, favorable evidence on the role of genetics in TBI recovery continues to grow. We aim for this work to inform interested parties on the current landscape of research, highlight promising targets for gene therapy, and galvanize translation of findings into clinical trials.
This work is devoted to the study of the immediate and long-term results of treatment of patients with aneurysms of the upper third of the basilar artery with the use of endovascular treatment methods. PURPOSE OF THE STUDY: To evaluate the immediate and long-term results of endovascular treatment of patients with aneurysms of the upper third of the basilar artery. MATERIAL AND METHODS. The results of endovascular treatment of 91 patients with 95 aneurysms of the upper third of the basilar artery operated in the neurosurgical department #3 of the Prof. A.L. Polenov Russian Research Neurosurgical Institute from January 1, 2017 to March 31, 2023 were analyzed. RESULTS. The following endovascular methods were used: 1) selective aneurysm coiling (n=39); 2) stent-assisted coiling (n=35); 3) implantation of flow-diverting stent (n=21). Grade of occlusion for aneurysms treated with selective aneurysm coiling and stent-assisted coiling was classified according to the Raymond-Roy classification, as well as according to the Cekirge-Saatci classification for aneurysms treated with flow-diverting stents. In the group after spiral occlusion, 23 (60.5 %) aneurysms were totally (Class A), 8 (21.1 %) were subtotally (Class b), and 7 (18.4 %) were partially (Class C) occluded. In the group after stent-assisted coiling totally occluded (Class A) were 22 (61.1 %), subtotally (Class b) — 8 (22.2 %) and partially (Class C) — 6 (16.6 %), with no statistically significant differences in the group of braided and laser-cut stents (p = 0.571). In the group after implantation of the flow-diverting stent, primary reconstruction (grade 4A) was achieved in 15 (71.4 %) cases. Control cerebral angiography at a period not earlier than 6 months was performed in 72.5 % (n=69) of patients. In the long-term follow-up after aneurysm occlusion with detachable coils, control angiography was performed in 73.7 % (28/38) of observations, totally occluded (Class A) were 16 (57.1 %) and partially (Class C) — 12 (42.9 %). In this group the recurrence rate was 21.4 % (n=6), in 10.7 % (n=3) requiring repeated surgical intervention. In the remote period after aneurysm occlusion with stent-assisted coiling, control angiography was performed in 66.7 % (24/36). After occlusion of aneurysms with usage of stents made by laser cutting technology in the remote period there was a decrease in radicality of aneurysms occlusion — (Class A) — 5 (38,4 %) and partially (Class C) — 8 (61,5 %). There were 7 recurrences in this group of cases, 4 of which required repeated surgical treatment. In the remote period after occlusion of aneurysms with stent-assisted coiling, with usage of braided stents there was an increase in radicality of aneurysms occlusion from blood flow. Totally were occluded (Class A) 10 (90.9 %) and partially (Class C) — 1 (9.1 %). In this group, 1 (9.1 %) recurrence was identified. In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases. Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6). Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome. In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases. Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6). Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome. CONCLUSION. Endovascular treatment of aneurysms of the upper third of the basilar artery with microspirals and / or with the use of other modern endovascular techniques is effective and safe enough. The use of modern braided assisting stents allows to achieve higher radicality of aneurysm occlusion in the long term period. Safety and efficacy of flow-directing stents in the treatment of aneurysms of the upper third of the basilar artery require further study; however, our results indicate the possibility of their effective usage of this treatment modality for complex aneurysms of this localization.
Magnetic resonance (MR) relaxometry, or measurement of tissue magnetic relaxation properties, is a technology intended to quantitatively depict the physical basis of structural MR imaging. This review is devoted to perspective directions of studies and application of MR relaxometry in brain glioma preoperative and pretherapeutic diagnosis. The current data advocate for emerging capabilities of relaxometry in glioma grading (despite possible overlap between different grades) and differentiating between gliomas and tumors of other origin. Some studies showed features of relaxometric values within the perifocal infiltrative edema zone possibly related to glioma infiltrative growth. We separately reviewed the works aimed at searching for the most aggressive and malignant foci in glioma tissue and extremely useful for tumor biopsy or removal. No less important are capabilities of relaxometry in radiogenomics, first of all, in IDH status prediction. The relaxometric method possesses perspective in multiparametric brain glioma diagnostics.
Objective: Septum pellucidum is a thin midline brain structure located in the anterior brain, running in a median-sagittal or midsagittal direction. This study aims at testing whether cavum septum pellucidum (CSP) and cavum vergae (CV) could predict clozapine pre- scribing in patients with schizophrenia. This study also assesses the relationship between CSP/CV and some clinical findings in patients with schizophrenia. Methods: 190 patients diagnosed with schizophrenia who underwent neuroanatomical evaluation with magnetic resonance imaging during inpatient treatment were included in the study. A personal data form, Positive and Negative Syndrome Scale (PANSS) were given to each patient at admission and discharge. The presence or absence of CSP/CV was recorded as “yes” or “no”. Results: The presence of CSP/CV was found to be associated with the number of hospital admissions, the number of electroconvulsive therapy sessions received, PANSS total score at admission, PANSS total score at discharge and clozapine use. In the logistic regression model created, the presence of CSP and total PANSS score were found to predict clozapine prescribing (respectively p = 0.001, p = 0.016). The Nagelkerke’s R2 value was found to be 0.167. Conclusions: This study holds the distinction of being the first in the field to investigate the relationship between clozapine prescribing and the presence of CSP/CV in schizophrenia patients. There is a need for longitudinal-cohort studies that can better express effect to identify the conditions associated with CSP/CV.
INTRODUCTION : An important task of modern pediatrics is to ensure radiation safety of diagnostic examinations, especially in young children. One of the options for reducing radiation exposure at the stages of screening diagnostics and dynamic monitoring is a wider use of ultrasound. OBJECTIVE: To analyze the data of domestic and foreign literature on the possibilities of ultrasound examination of the cranial vault bones, cranial sutures and scalp in children. MATERIALS AND METHODS : The literature search was performed in open Russian and English databases Medline, PubMed, Web of Science, RSCI, eLIBRARY using keywords and phrases: «skull ultrasound», «scalp ultrasound», «cranial sutures ultrasound», «point of care ultrasound», «pediatric POCUS» without limitation of retrospective depth. RESULTS: Based on the literature data and our own long-term experience in the use of cranial ultrasonography in clinical practice, the indications and examination technique, as well as the key ultrasound signs of the most frequent types of pathology are described. Prospects of scalp and skull ultrasonography within PoCUS, FAST, including the use of portable sonoscopes based on smartphones and tablets are outlined. CONCLUSION : Ultrasound of the skull and scalp is a quick, simple, affordable, harmless method of screening and monitoring the most frequent types of pathologies of the cranial vault bones, cranial sutures, and soft tissues of the scalp in children (for example, fractures, synostoses, neoplasms).
Trigeminal neuralgia (TN), a severe facial pain condition, is often treated with microvascular decompression (MVD). While MVD is effective for arterial neurovascular compression, its efficacy in cases of venous compression and the intraoperative management of such cases remain areas of debate. This review aimed to analyze the intraoperative management strategies for offending veins during MVD and evaluate the outcomes of these procedures in cases of TN with purely venous compression. An extensive review of studies reporting on the intraoperative handling of veins and the surgical outcomes of MVD in purely venous compression cases was conducted. Fifteen full-text studies were included, encompassing a total of 600 patients. Notably, 82.33% of these patients achieved a Barrow Neurological Institute (BNI) I pain score, with follow-up periods ranging from 3 months to 12 years. MVD is a viable and effective treatment option for TN in cases of venous compression, with a significant proportion of patients experiencing substantial pain relief.
The article presents a case of giant clival meningioma treatment. Giving the presence of hydrocephalus, manifested by the Hakim-Adams triad and inoperable size of the tumor, the patient underwent VPS implantation. Followup has shown slow progression of the tumor and syringomyelia formation.
Background/Objectives: Patient positioning during surgery can influence intra- and postoperative complications. Therefore, we assessed the impact of the sitting and park-bench positions on anesthetic parameters and complications in neurosurgical patients. Methods & Patients: For this retrospective study, 314 adults who underwent neurosurgical procedures for posterior fossa pathologies were divided into two groups: sitting (n=231) and park bench (n=83). The following data were collected, monitored, recorded and compared: age, sex, tumor type, surgical approach, cardiovascular and respiratory complications, and postoperative surgical complications. The association of hypotension with position was further investigated through multivariate logistic regression models by adjusting for CO2 decrease, desaturation and documented gas embolism. Results: The average age was significantly lower in the sitting group (55 years, interquartile range (IQR)=43-63; female proportion=59.74%) than in the park-bench group (62 years, IQR=45-74; female proportion=57.83%) (p<0.001). Cerebellopontine angle tumors were detected in 37.23% of the patients who underwent operation in the sitting position and in 7.26% who underwent operation on in the park-bench position (p<0.001). Patients in the sitting position had significantly greater anesthetic complication (91.77% vs. 71.08%, p<0.001), hypotension (61.9% vs. 16.87%),and >2-mmHg CO2 decrease (35.06% vs. 15.66%, p<0.001) incidences. Hypoxemia and death occurred more frequently in the park-bench group (8.43% vs. 1.73% and 6.03% vs. 1.3%, respectively). Conclusions: Compared with the park-bench position, the sitting position was associated with a greater specific anesthetic complication incidence and lower postoperative mortality rate, indicating a need for careful risk‒benefit assessment when selecting each individual patient’s surgical position.
Breast cancer, lung cancer and melanoma exhibit a high metastatic tropism to the brain. Development of brain metastases severely worsens the prognosis of cancer patients and constrains curative treatment options. Metastasizing to the brain by cancer cells can be dissected in consecutive processes including epithelial-mesenchymal transition, evasion from the primary tumor, intravasation and circulation in the blood, extravasation across the blood-brain barrier, formation of metastatic niches, and colonization in the brain. Ion channels have been demonstrated to be aberrantly expressed in tumor cells where they regulate neoplastic transformation, malignant progression or therapy resistance. Moreover, many ion channel modulators are FDA-approved drugs and in clinical use proposing ion channels as druggable targets for future anti-cancer therapy. The present review article aims to summarize the current knowledge on the function of ion channels in the different processes of brain metastasis. The data suggest that certain channel types involving voltage-gated sodium channels, ATP-release channels, ionotropic neurotransmitter receptors and gap junction-generating connexins interfere with distinct processes of brain metastazation.
BACKGROUND: The brain area stimulated during repetitive transcranial magnetic stimulation (rTMS) treatment is important in altered states of consciousness. However, the functional contribution of the M1 region during the treatment of high-frequency rTMS remains unclear. OBJECTIVE: The aim of this study was to examine the clinical [the Glasgow coma scale (GCS) and the coma recovery scale-revised (CRS-R)] and neurophysiological (EEG reactivity and SSEP) responses in vegetative state (VS) patients following traumatic brain injury (TBI) before and after a protocol of high-frequency rTMS over the M1 region. METHODS: Ninety-nine patients in a VS following TBI were recruited so that their clinical and neurophysiological responses could be evaluated in this study. These patients were randomly allocated into three experimental groups: rTMS over the M1 region (test group; n = 33), rTMS over the left dorsolateral prefrontal cortex (DLPFC) (control group; n = 33) and placebo rTMS over the M1 region (placebo group; n = 33). Each rTMS treatment lasted 20 min and was carried out once a day. The duration of this protocol was a month with 20 treatments (5 times per week) occurring with that time. RESULTS: We found that the clinical and neurophysiological responses improved after treatment in the test, control, and placebo groups; the improvement was highest in the test group compared to that in the control and placebo groups. CONCLUSIONS: Our results demonstrate an effective method of high-frequency rTMS over the M1 region for consciousness recovery after severe brain injury.
Aim. This review aims to inform physicians of different specialties (anesthesiologists, intensivists, neurologists, neurosurgeons, oncologists) about the diagnostic capabilities of microwave radiothermometry, which enables to identify and analyze features of alterations of cerebral temperature in brain damage. The review displays a critical analysis of 80 recent Russian and foreign open access publications found by keywords. The review presents major clinical features and pathophysiological mechanisms of cerebral thermal balance disruptions in brain lesions. Slow responsiveness and vulnerability of cerebral thermal homeostasis regulation mechanisms that underlie development of different temperature heterogeneity levels in the cerebral cortex in healthy brain and brain lesions are highlighted. The authors postulate their concept about the critical role of hyperthermia in the pathogenesis of brain damage and disruption of interconnections in the global central regulation system. A body of evidence explaining direct association between the depth of consciousness impairment and degree of cerebral cortex temperature heterogeneity manifestation is presented. It is emphasized that a significant increase in temperature heterogeneity with areas of focal hyperthermia accompanies an acute period of ischemic stroke, while in post-comatose state usually associated with prolonged impairment of consciousness, the temperature heterogeneity significantly subsides. It has been suggested that lowering of an increased and rising of the reduced temperature heterogeneity, for example by using temperature exposure, can improve altered level of consciousness in patients with brain damage. The diagnostic capabilities of various technologies used for cerebral temperature measurement, including microwave radiothermometry (MWR), are evaluated. Data on high accuracy of MWR in measurement of the cerebral cortex temperature in comparison with invasive methods are presented. Conclusion. In healthy individuals MWR revealed a distinct daily rhythmic changes of the cerebral cortex temperature, and badly violated circadian rhythms in patients with brain lesions. Since MWR is an easy-toperform, non-invasive and objective diagnostic tool, it is feasible to use this technology to detect latent cerebral hyperthermia and assess the level of temperature heterogeneity disruption, as well as to study the circadian rhythm of temperature changes.
BACKGROUND/OBJECTIVE: Spinal arachnoid cysts (SAC) are intradural lesions, which may provoke a compression of the spinal cord and roots. Endoscopic techniques are increasingly used to minimize the surgical access and the postoperative scar tissue. Shunts may also represent an option. The aim of this paper is to illustrate the technique of endoscopic-assisted fenestration and positioning of a cysto-peritoneal diversion in a thoracic SAC using a flexible endoscope and to perform a systematic literature review on this subject. MATERIAL AND METHODS: We reported our case and we performed a review of the literature, searching for all the adult cases of Type III SACs in English language treated through endoscopic procedures. RESULTS: We found 5 articles matching our search criteria and we included 9 adult patients in our analysis. Six patients were females and the most common localization was the thoracic spine. Six patients underwent selective laminectomies followed by endoscopic fenestration without cyst wall resection. Three patients had a percutaneous endoscopic inspection of the cyst and in two cases a cysto-subarachnoid shunt space was performed. Improvement of pre-operative neurological deficit was reported in six patients, no patients experienced clinical deterioration. The mean follow-up was 22 months and no progression or recurrence was reported. CONCLUSION: The implementation of endoscopy allows a minimally invasive treatments with good visualization of cyst anatomy and precise shunt positioning under real-time guidance. Endoscopy is technically demanding but it can offer similar clinical outcomes when compared to microscopic procedures with a limited rate of post-operative complications.The long-term risk of recurrence should be established by prospective studies.
Objective: What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests? Data Sources: PubMed Medline, Elseviers's Embase, and the six databases of Cochrane Library. Methods: We conducted a systematic search on December 20, 2022, consisting of synonyms for EGM. We considered randomized controlled trials and observational studies with original data for inclusion if they included adults who underwent electrogustometry. Articles were excluded if no analysis regarding validity, reliability, or diagnostic accuracy had been performed or if these analyses could not be performed with the published data. Results: Nineteen articles discussing 18 studies were included for data extraction. The included studies carry a high risk of bias. Overall, the association between a variety of reference taste tests and EGM was moderate or weak with correlation coefficients ranging from -0.51 to 0.40 with one outlier of -0.74 found in one study correlating EGM and taste solutions. Test-retest reliability was good with reported correlation coefficients between 0.78 and 1.0. The sensitivity, specificity, PPV, and NPV of EGM in identifying abnormal taste function varied widely between the four studies on diagnostic accuracy. Conclusion: The included studies in this review lack the required standards regarding study design to draw firm conclusions about the validity, reliability, and diagnostic accuracy of the EGM. Future research is needed to assess these measurement properties. Based on the reported results, we would not recommend using the EGM as a screening test for taste disturbance in clinical practice. Level of Evidence: NA.
. One of the main purpose of various surgical operations is to preserve the nerves, since unintentional damage can lead to neurological deficits in the patient, including numbness, pain, local paralysis, and others. Nerve identification during surgery depends on a variety of parameters, including anatomy, texture, color, and relationship to surrounding structures using white light illumination. The use of fluorescent labeling of nerves may enhance the contrast between nerves and adjacent tissues during surgery, which may lead to improved outcomes. PURPOSE OF THE STUDY . Analysis of the results of pilot studies in the field of fluorescent biovisualization of nerves in relation to neurosurgical practice. MATERIALS . The analysis includes publications reporting on the results of the application of methods of fluorescent biovisualization of nerves with different fluorescence inducers. RESULTS . Currently, promising photosensitizers that have most of the desired characteristics for in vivo image-guided fluorescent nerve surgery are fluorescents GE3126, oxazine 4, Cy5-NP41. CONCLUSIONS . Under ideal conditions, in vivo fluorescence imaging of nerve fibers is superior to other methods due to its real-time signal acquisition, high spatial resolution, high sensitivity, ease of operation, and low cost. Although fluorescence imaging techniques are not widely used in the clinical identification of nerves, they show exceptional promise for significantly reducing the risk of neurological deficits.
The difficulty of intraoperative delineation of glial tumors is due to the peculiarities of their growth along vessels and nerve fibers with infiltration of healthy white matter. Insufficiently complete removal of tumor tissues leads to recurrences, and excessive removal is fraught with neurological complications. Optical spectroscopy methods are characterized by high speed, accuracy and non-invasiveness, which determines the prospects of their use for intraoperative demarcation of the boundaries of such tumors. Fluorescence and diffuse reflectance spectroscopy have found wide application in intraoperative neuronavigation, mainly for detecting the edges of diffuse gliomas. At the same time, in recent years the direction of <i>ex vivo</i> spectral analysis of tumor samples using a combination of various optical spectroscopy methods, including both elastic and inelastic scattering spectroscopy, has been actively developed. Obviously, the ability to obtain spectra intraoperatively and on fresh specimens is different. The present article compares the results of the analysis of optical-spectral characteristics of intracranial tumors at intraoperative diagnosis and <i>ex vivo</i> analysis and proposes a mathematical model for interpretation of the observed dependencies.
The objective was to analyze and evaluate patients` quality of life before and after resection of brain meningioma. Methods and materials. We performed study of 31 patients with brain meningioma. The diagnosis of the studied patients was based on clinical and laboratory data, data of radiation and instrumental methods of research. The analysis of patients` quality of life was carried out in the preoperative, early and late postoperative periods. The patient` age ranged from 37 to 65 years; the median age was 57 years. We chose a special questionnaire-EORTC QLQ-C30 to assess quality of life of the studied pre- and postoperative periods. The questionnaire has been tested in many international clinical studies. Results. In the early postoperative period, the severity of pain increased in the patients under study, nausea and vomiting, constipation occurred more often. However, patients assessed their General health in both early and late postoperative periods better than before the operation. In the late postoperative period, there was a positive dynamics in all scales of the questionnaire. Conclusion. On examination of various parameters of quality of life before and after surgery in patients with brain meningioma, it was found that surgical intervention led to an improvement in the quality of life of patients.
PURPOSE: To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facet-preserving laminectomy for the treatment of patients with degenerative lumbar stenosis. METHODS: A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. RESULTS: A total of four high-quality RCTs and six low-quality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. CONCLUSION: The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.
The main etiological factors of nerve damage to the head and neck include injuries, oncological diseases, iatrogenic injuries during surgical interventions. An important task of treatment is to restore the lost function of the nervous head and neck, the functions of which certainly determine the quality of life of the patient. The article presents modern methods of nerve reconstruction of the head and neck. The methods of reconstructive surgery of the facial, trigeminal, inferior alveolar, lingual, recurrent laryngeal nerves are described. This article also describes the types of rehabilitation after reconstructive operations on the nerves of the head and neck using pharmacological and non-pharmacological treatment methods such as botulinum therapy, neuromuscular retraining, taping, post-isometric relaxation, acupuncture, phonophoresis, gymnastics.
SUMMARY: A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6-7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. LEARNING POINTS: Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.