scholarly journals Surgical treatment of patients with primary and metastatic spinal tumor with use of the O-Arm intraoperative portable computed tomography scanner

2019 ◽  
Vol 21 (4) ◽  
pp. 39-49
Author(s):  
A. A. Sufianov ◽  
V. I. Manashchuk ◽  
D. N. Nabiev ◽  
A. G. Shapkin ◽  
M. K. Zaytsev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Informed Consent ◽  
Conflict Of Interest ◽  
Navigation System ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Neurological Status ◽  
Spinal Tumors ◽  
Study Objective ◽  
Mass Lesions

The study objective is to demonstrate our experience of employment of O-Arm intraoperative portable сomputed tomography scanner combined with navigation system Stealth Station Treon Plus (Medtronic Navigation) during decompressive-stabilizing surgeries for patients with primary and metastatic spinal tumors.Materials and methods. We have reviewed results of surgical treatment of 44 patients (24 males and 20 females, average age is 54.3 ± 1.8), who were hospitalized and operated in the department of spinal neurosurgery in Federal Centre of Neurosurgery (Tyumen). All surgeries were performed by one surgical team in the period of April 2011 to June 2017. All patients underwent full clinical examination according to diagnostic algorithm, including assessment of general condition, degree of bone and visceral dissemination, neurological status, quality of life, pain syndrome intensity. The most common cause of vertebral lesions was plasma cell myeloma (15 patients, 34.1 %), metastatic spinal lesions (12 patients, 27.3 %). Patients were subjected to posterior decompression and stabilization with total and subtotal excision of mass lesions. Assessment of degree of decompression and transpedicular fixation were carried out visually using O-Arm combined with navigation station.Results. In 6 to 12 months after surgery 79.5 % of patients demonstrated significant improvement of neurological status, specifically a decrease of conduction and sensory disorders. Degree of pain syndrome was reduced by 3.6 times. Using O-Arm combined with navigation station we placed screws adequately in 99.6 % of the cases. The main technical problem that occurred during the surgery was the failure of navigation system caused by: defect of reflective spheres, distant installation and shift of referential frame, aging of Jamshidi needle, malfunction of navigation camera, failure of data transfer from navigation station.Conclusion. The use of O-Arm combined with navigation station for decompressive and stabilizing surgeries in patients with spine and spinal cord tumors let us perform surgeries with 3D control and navigation, conduct surgeries in areas where it is hard to determine surgical landmarks, ensure precision of transpedicular screw implantation, accomplish total resection of mass lesions with minimal blood loss and less aggressive surgical intervention and properly decompress the spinal canal which, eventually, result in positive anatomical and functional characteristics, and contribute to good general outcome of surgical intervention.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

scholarly journals Videoimage endoscopy in surgical treatment of patients with upper orbital roof fractures

2019 ◽  
Vol 21 (4) ◽  
pp. 50-56
Author(s):  
O. V. Levchenko ◽  
A. A. Kalandari ◽  
N. Yu. Kutrovskaya
Keyword(s):  
Surgical Treatment ◽  
Informed Consent ◽  
Conflict Of Interest ◽  
Ocular Motility ◽  
Septic Complications ◽  
Study Objective ◽  
Orbital Roof ◽  
Anterior Cranial Base ◽  
Rehabilitation Period ◽  
Written Informed Consent

The study objective is to assess the effectiveness and safety of videoimage endoscopy during minimally invasive surgery in fractures of the upper orbital roof.Materials and methods. We examined and operated 9 patients (7 men and 2 women) aged 16 to 53 years (mean age 28.4 years) with fractures of the upper orbital roof with intraorbital (n = 7) and intracranial (n = 2) fragments displacement. Surgery was aimed at eliminating oculomotor disorders, preventing purulent-septic complications and restoring tightness of the intracranial space and orbital anatomy. All patients were operated using 4 mm rigid endoscopes with 0 and 30° viewing angles.Results. All patients underwent fraction resection and intraorbital structures decompression. No case of intraoperative liquorrhea was registered. The surgery did not change visual acuity. Ocular motility disturbances were eliminated in all patients. Videoimage endoscopy made it possible to avoid wide craniotomy used to approach orbital roof and to shorten the rehabilitation period and hospitalization time. With intraorbital fragments displacement it allowed to reconstruct the orbit with minimal eyeball traction, while preserving important neurovascular bundles, as well as simultaneously revise dura mater and anterior cranial base in order to exclude intraoperative liquorrhea. No complications of surgical treatment were reported.Conclusion. The results demonstrate the wide possibilities of endoscopy in cranioorbital lesions surgery.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

scholarly journals Prevention of pain syndrome and immediate postoperative complications in the surgical treatment of chronic hemorrhoids

2020 ◽  
pp. 68-71
Author(s):  
V. N. Ishchenko ◽  
A. E. Krasnobaev ◽  
A. A. Grigoryuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Modified Technique ◽  
Postoperative Urinary Retention ◽  
Clinical Comparison ◽  
Suggested Technique

Objective: To assess the efficacy of hemorrhoidectomy with Milligan-Morgan technique in the author’s modification.Methods: Results of surgical treatment of 558 patients aged 21–72 years with complicated hemorrhoids of III–IV stage were analyzed. The group of clinical comparison (207 patients) was operated according to standard scheme, the main group (351 patients) – according to author’s technology with modified technique for treating the hemorrhoid bolus using betamethasone.Results: When using the author’s technique, a more significant decrease in postoperative pain syndrome severity was achieved: injection analgesics were not required already in a day, and after 6 days the pain syndrome was stopped in all cases. Only three patients (0.9%) demonstrated an acute urinary retention up to two days. The group of clinical comparison maintained a longterm (up to three months) pain syndrome; postoperative urinary retention was registered in 38 cases (18.4%); 9 patients (4.3%) developed blood loss in the area of surgical intervention.Conclusions: Suggested technique of surgical treatment for hemorrhoids is quite effective, simple and can be implemented in any surgical inpatient facility. 

scholarly journals Minimally invasive surgery for spine osteomyelitis treatment

2021 ◽  
pp. 104-110
Author(s):  
Ye.Ya. Kochnev ◽  
◽  
S.Vl. Lyulin ◽  
S.V. Mukhtyaev ◽  
I.A. Meshcheryagina ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Intervention ◽  
Life Quality ◽  
Pain Syndrome ◽  
Minimally Invasive Surgical ◽  
Minimally Invasive Surgical Treatment

The aim of the research is to study the results of minimally invasive surgery for the treatment of nonspecifi c infectious spine lesions, and to present personal experience. Material and methods. Three patients with purulent nonspecifi c spondylodiscitis of lumbar spine got minimally invasive surgical treatment. The essence of surgical intervention included X-ray-assisted placement of tubular retractors in the area of intervertebral disc aff ected by purulent process; debridement and irrigation with antiseptic solution of interbody space, and setting a drain tube. All patients were treated during the period from December 2016 to February 2019. They were examined before surgery and in 3 months aft er the discharge. Laboratory parameters (CBT, C-reactive protein, bacteriological analysis of intervertebral disc contents) and instrumental research methods (computer tomography, magnetic resonance imaging) were evaluated. ODI, VAS, SF-36 questionnaires helped to assess pain syndrome and life quality of patients. Results. In 100 % of studied cases infection was caused by Staphylococcus aureus. The result of treatment in all cases was assessed as good, because pain syndrome, neurological disorders and inflammatory process were arrested; there were no signs of disease progression. In all cases, life quality of patients was restored. In one case, additional surgical intervention was required (posterior instrumental fi xation of spine) because of instability signs. Conclusion. Minimally invasive surgical treatment of purulent single-level spondylodiscites can be recommended for practical use. The use of such approache allows to verify purulent infection agent, to damage soft tissues less getting proper sanitation of interbody space. It also allows to stop the infection and restore life quality of a patient

scholarly journals Prognostic value of the Tokuhashi scale when choosing a method of surgical treatment of metastatic lesions of the spine

2021 ◽  
Vol 13 (3) ◽  
pp. 63-75
Author(s):  
M. A. Kosimshoev ◽  
A. V. Evsyukov ◽  
Yu. E. Kubetskiy ◽  
E. K. Uzhakova ◽  
E. V. Amelina ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Life Expectancy ◽  
Cox Model ◽  
Prognostic Significance ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Study Objective ◽  
Spinal Lesion ◽  
Preoperative Examination

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

scholarly journals Muscular syndrome manifestations at the patients in the late postoperative period after the herniation of invertebral disk surgical treatment

2008 ◽  
Vol 7 (5-2) ◽  
pp. 448-450
Author(s):  
S. A. Fedyanin
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Spinal Canal ◽  
Pain Syndrome ◽  
Neurological Status ◽  
Resonance Imaging ◽  
Canal Stenosis ◽  
Adjacent Segments ◽  
Ultrasound Investigation ◽  
Late Postoperative Period

Checkup of 215 patients in the late period after the dick herniation surgical treatment. Middle age (45,6 ± 0,6) years. Postoperative period is (7,4 ± 0,4) years. The patients were examined: neurological status, lumbar spine radiography, magnetic resonance imaging procedure, spinal canal ultrasound investigation, muscular syndrome index determination. Revealed pain syndrome caused by the disk herniation relapse in operated and adjacent segments, spondylosis and spondylarthrosis, spinal canal stenosis, aseptic epiduritis. The pain syndrome at those patients entails by development of the muscular syndrome and pathologic motor skill.

scholarly journals THE APPLICATION OF NAVIGATION SYSTEM BASED ON THE AUGMENTED REALITY TECHNOLOGY FOR THE SURGICAL TREATMENT OF ORBITAL TUMORS

2021 ◽  
Vol 29 (1) ◽  
pp. 67-74
Author(s):  
I.Y. Zherka ◽  
◽  
K.P. Zhiliayeva ◽  
L.V. Naumenka ◽  
Zh.V. Kaliadzich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Augmented Reality ◽  
Navigation System ◽  
Preoperative Planning ◽  
Surgical Intervention ◽  
Intraoperative Navigation ◽  
Orbital Tumors ◽  
Bony Landmarks ◽  
Augmented Reality Technology

Objective. To assess the effectiveness and feasibility of using an intraoperative navigation system based on augmented reality technology in the surgical treatment of intra-orbital tumors. Methods. Two patients with intra-orbital tumors were operated on with the application of the intraoperative navigation system. The virtual volumetric model was designed on the basis of files in the Digital Imaging and Communications in Medicine (DICOM) format, taking into account the fact that the quality of reconstruction depends on the quality of the input data and the accuracy of the reconstruction system. The required structures and parameters of color rendering for inclusion in the model were selected taking into consideration a specific clinical situation. Then the model was subjected to processing and modification to facilitate visualization. The prepared and optimized model was loaded into Microsoft HoloLens2 augmented reality glasses. In the preoperative period, using the possibilities of full screen image zoom and rotation of 3D model, the planning of the surgical intervention was carried out with the participation of all members of the surgical team. Intraoperatively, a 3D skull model was superimposed on the patient along bony landmarks (lower orbital edge and nasal bones). Surgical access and surgery were performed in the projection of the visualized tumor. Results. In the first case, the surgical planningas the preoperative method of pre-visualising asurgical intervention was used by means of the possibilities of model zooming and rotating; a detailed preoperative tumor assessment was made. In the second case, the navigation system was used in the process of diagnostic orbitotomy to facilitate the access to the tumor. Conclusion. Augmented reality allows highly detail visualization of individual anatomical models. Models are interactive, adaptive to real time and manipulating does not require the special skills. The technologies are flexible and can be programmed to perform a number of tasks (diagnostics, preoperative planning and intraoperative navigation). Models might be used for surgical training of surgeons to possess the skills. What this paper adds For the first time, the possibility of a navigation system application based on augmented reality technology in the surgical treatment of intra-orbital tumors has been shown. The technique has been found to be useful both in the preoperative planning and during surgical intervention.

scholarly journals Multilevel radical resection in treatment of patients with spine tumors

2021 ◽  
Vol 13 (2) ◽  
pp. 11-17
Author(s):  
R. M. Kabardaev ◽  
E. R. Musaev ◽  
A. K. Valiev ◽  
K. A. Borzov ◽  
S. F. Kuznetsov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Malignant Tumors ◽  
Disease Free Survival ◽  
Functional Results ◽  
Radical Resection ◽  
Spinal Tumors ◽  
Benign Tumors ◽  
Study Objective ◽  
Surgical Interventions ◽  
National Medical

Introduction. Radical surgical resections in the treatment of malignant tumors of the spine have proven effective in improving both overall and disease-free survival of patients. Indications for such interventions are primary malignant tumors of the spine, primary benign tumors with aggressive growth, and solitary metastatic lesions in patients with a favorable oncological prognosis. Due to the anatomical features of the vertebral column, it is very difficult to perform radical resections. An even more difficult task is to perform such interventions for multilevel spinal lesions.The study objective is to evaluate the results of radical surgical treatment for multilevel tumor lesions of the spine.Materials and methods. From 2004 to 2019, in the department of spine surgery of the N.N. Blokhin National Medical Research Center of Oncology treated 36 patients with spinal tumors, who underwent multilevel radical resections. The analysis of this surgical treatment of patients with multilevel neoplastic lesions of the spine was carried out.Results. Performing radical surgical interventions on the spine makes it possible to reduce the frequency of local relapses, improve functional results and overall survival of patients. After performing multilevel resections, complications often occur.

scholarly journals Minimally invasive surgical treatment of a patient with pathological tortuosity of the carotid artery using endoscopic assistance

2019 ◽  
Vol 20 (4) ◽  
pp. 80-86 ◽  
Author(s):  
V. A. Lukyanchikov ◽  
R. Kh. Khasauov ◽  
Z. U. Kozhaev ◽  
Zh. S. Gekkieva ◽  
V. V. Krylov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Neurological Status ◽  
Left Internal Carotid Artery ◽  
Parotid Glands ◽  
Study Objective ◽  
Advantages And Disadvantages ◽  
Minimally Invasive Surgical ◽  
Endoscopic Assistance ◽  
Minimally Invasive Surgical Treatment

The study objective is to describe a clinical case of surgical treatment of a patient with pathological distal tortuosity of the left internal carotid artery (ICA) and present a comprehensive description of a proposed surgical technique, as well as compare advantages and disadvantages of the chosen and alternative surgery types.Materials and methods. At the 1st stage, we performed computed angiography and triplex scanning of the main head arteries and modelled operative approach. At the 2nd stage, we mapped the ICA approach, redressing and resection. At the 3rd stage, using endoscopic assistance we separated the ICA along its entire length, found its pathological kink, performed ICA redressing and resection with subsequent reanastomosis with high accuracy and minimal injury.Results. ICAblood flow was 320 ml/min (prior to surgery: 140 ml/min). In the postoperative period, positive dynamics of the patient’s neurological status were observed. Computed angiography and triplex scanning confirmed removal of pathological tortuosity. Compared to the proposed technique, other surgery types (open access) are characterized by high risk of injury of the cranial nerve branches, submandibular and parotid glands, necessity of dissection of the digastric, stylohyoid muscles, subluxation of the mandibula, etc.Conclusion. The method of allocation of hard to reach tortuosities of the carotid artery developed based on previously known endoscopic manipulations on the vessels of the extremities using endoscopic assistance allows to decrease injury during the intervention and achieve maximal technical and clinical effect.

scholarly journals Interlaminar decompression for patients with degenerative lumbar stenosis. Literature review and results of a prospective study

2019 ◽  
Vol 21 (4) ◽  
pp. 57-66 ◽  
Author(s):  
A. A. Grin ◽  
A. S. Nikitin ◽  
A. A. Kalandari ◽  
S. A. Asratyan ◽  
S.‑E. R. Yusupov
Keyword(s):  
Informed Consent ◽  
Prospective Study ◽  
Satisfactory Result ◽  
Conflict Of Interest ◽  
Herniated Disc ◽  
Lumbar Stenosis ◽  
Study Objective ◽  
Clinical Instability ◽  
One Year ◽  
A Prospective Study

The study objective is to assess the effectiveness of interlaminar decompression in patients with degenerative lumbar stenosis.Materials and methods. A prospective study was conducted among 100 patients with degenerative lumbar stenosis. All patients were operated, interlaminar decompression of the symptomatic side was made. Outcomes were assessed by using a visual analogue scale and Oswestry questionnaire 1 and 2 years after surgery. Among patients with an unsatisfactory result, the cause of the unsatisfactory outcome was studied.Results. One year after surgery a satisfactory result was noted in 71 patients, and 2 years after surgery a satisfactory result was noted in 67 patients. The following causes of unsatisfactory outcome were found in 33 patients: 9 – spinal canal restenosis, 2 – herniated disc at the operation level, 4 – the facet syndrome, 4 – development of clinical instability, 3 – pain in the opposite leg (there was no pain before the operation), 2 – development of delayed radiculopathy, 9 – decompensation of concomitant diseases (4 – coxarthrosis, 3 – gonarthrosis, 2 – chronic ischemia of the lower extremities). Among the risk factors for restenosis, statistically significant relationship was found only with the presence of spondylolisthesis.Conclusion. Interlaminar decompression is an effective surgical option in patients with degenerative lumbar stenosis. The presence of spondylolisthesis is a risk factor for the inefficiency of this operation.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

scholarly journals Using stent retriever pRESET during embolization of intracranial aneurisms

2019 ◽  
Vol 21 (4) ◽  
pp. 24-28
Author(s):  
M. Yu. Volodyukhin
Keyword(s):  
Informed Consent ◽  
Conflict Of Interest ◽  
Stent Retriever ◽  
Technical Success ◽  
Brain Aneurysm ◽  
Study Objective ◽  
Neurological Outcomes ◽  
Written Informed Consent ◽  
Temporary Stent ◽  
Additional Option

The study objective is to present the results of applying stent retriever pRESET as assistance device in embolization of brain aneurysm.Materials and methods. Between January 2017 and May 2018, were threated 10 patients with brain aneurism using temporary stent-assistant method. The average aged was 41. Asymptomatic aneurysmal disease was observed in five patients, two patients were operated on in the acute period of subarachnoid hemorrhage, in two cases temporary stent assistance was used for pre-embolization of previously operated aneurysms. Temporary stent assistance was performed using a stent retriever pRESET (Phenox, Germany).Results. The technical success of the intervention was 100 %. Total embolization of aneurysms was achieved in seven patients, in three patients subtotal embolization was observed. All observations had positive neurological outcomes on discharge.Conclusion. Temporary stent assistance using a stent retriever pRESET is an additional option for endovascular treatment of brain aneurysms.Conflict of interest. The author declares no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study

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