Long-term results of treatment of pharmacoresistant temporal lobe epilepsy

The aim of the study wasto evaluate the long-term results ofsurgicaltreatment of patients with pharmacoresistant epilepsy.Materials and methods. A retrospective analysis of treatment outcomes in patients with drug-resistant temporal lobe epilepsy was performed. According to the inclusion and exclusion criteria, 96 patients were selected for the study. Group 1 contained 49 operated patients with MR-positive epilepsy and Group 2 contained 47 operated patients with MR-ne‑ gative epilepsy. The control group consisted of 53 unoperated patients. The outcomes ofsurgical treatment were assessed after 6, 12, and 24 months. Results. Unfavorable outcomes occurred more frequently among nonoperated patients compared to both surgical groups (p <0.001). The probability of the 2-year remission after surgery in operated MRI positive patients was 60 %, in MRI negative group was 45 %, and in conservative group – only 2 %. The mean duration of the seizures-free period was greatest̆in the MRI positive surgical group (15.4 ± 1.5 months), and shortest in the control group (3.3 ± 0.9 months).Conclusion. The presented results prove the effectiveness and safety of surgical treatment of patients with temporal lobe epilepsy.

Skull base meningiomas: development of treatment methods

The review describes the treatment methods for skull base meningiomas and promising modern trends in this area. The most significant events in the development of meningiomas’ surgical treatment are described. The current research and scientific approaches to the skull base meningiomas’ treatment are presented: medical robotic systems, targeted therapy, radiosurgery, and proton therapy.

Features of TLIF/PLIF in lumbar spine nerve root anomalies. The literature review and own experience

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre & Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (>2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.

The possibility of simultaneous combined skin grafting during the installation of synthetic implants after cranial trepanation

Introduction. Over the past 20 years, with an increase in the number of decompression trepanations in the Russian Federation and abroad, the number of cranioplasties performed has increased. Despite the development of technology, these surgical interventions are inevitably accompanied by a number of complications (up to 36 %), including the for‑ mation of skin defects. The choice of the optimal algorithm for the treatment of skin defects after cranioplasty remains the subject of debate.The purpose of the publication is to demonstrate by a clinical example the possibility of simultaneous combined skin grafting during the installation of synthetic implants after cranial trepanation, as well as to analyze the outcomes and com‑ plications of such operations.Materials and methods. For the period 2017–2019 under our supervision there were 42 patients after craniotomy, 32 of which were cranioplasty, and 10 plastic surgery of the defects of the scalp after removal of synthetic implants. In the course of the analysis, the structure and terms of surgical interventions, the length of hospitalization, the frequen‑ cy and structure of complications, as well as the timing of their development were studied.The article presents one of the cases of treatment and simultaneous installation of a titanium plate, combined skin grafting in a patient who has undergone previously decompressive craniotomy, cranioplasty with protacryl.Results. Simultaneous cranioplasty with skin grafting was performed in 3 out of 42 patients. The average hospitalization time after such an intervention was significantly less than with two‑stage plastic surgery (28.0 ± 3.9 and 52.0 ± 2.7 days, respectively, p <0.05). There were no complications in the postoperative period after a single‑stage plastic surgery, but after a two‑stage one, 2 cases of divergence of the wound edges and the formation of fistulas above the implants were registered.Conclusion. The data obtained illustrate that, given the technical feasibility, as well as the satisfactory condition of the skin flap, simultaneous cranioplasty with combined skin grafting can be one of the methods of choice in the treat‑ ment of extensive defects in the skin of the head and skull.

The comparative study of invasive electroencephalography modalities in temporal lobe epilepsy

Introduction. Invasive video-EEG monitoring (invasive EEG) is indicated in patients with refractory focal epilepsy while localization of the epileptogenic zone is unclear. Methods of invasive EEG in different groups of patients demonstrate variable results.Objective: to analyse the results of invasive EEG via subdural and depth electrodes in patients with refractory temporal lobe epilepsy with mesial temporal lobe seizures.Materials and methods. The series of 37 patients who underwent invasive EEG from 2013 to 2020 was retrospectively analysed. The study includes primary adult patients with structural refractory focal epilepsy with mesial temporal lobe seizures without tumor and vascular pathology. Patients were divided onto 3 groups: 1) with foramen ovale electrodes 2) subdural strip electrodes and 3) combination of subdural strips and depths electrodes. The results of anteromedial temporal lobectomy after 6 months were classified according to Engel scale.Results. A group with foramen ovale electrodes included 7 patients, subdural strips – 23, combination – 7. The seizure onset zone was detected in 36 (97 %) cases. Serious complications were observed in 2 (29 %) cases in the group with foramen ovale electrodes. The mean follow-up in 23 (76 %) patients after resective surgery was 28.3 months. Favourable results (Engel I, II) were observed in 4 (80 %) patients with foramen ovale electrodes, in 8 (67 %) patients with subdural electrodes, in 6 (100 %) with combination. Unfavourable results (Engel III, IV) were noted in 1 (20 %) patient with foramen ovale electrode, in 4 (33 %) patients with subdural strips.Conclusion. All the presented modalities of invasive EEG are effective for localizing of seizure onset zone in this category of patients. Foramen ovale electrode using may be limited due to increased risk of complications.

Emotional burn-out and the doctor’s conscience

Doctor is one of the most “helping” professions associated with high emotional load and responsibility which frequent‑ ly lead to psychological and physical exhaustion. This condition was named emotional burnout syndrome. This article poses the questions on causes and consequences of this condition, risk of professional crisis and necessity of counte‑ raction.

Surgical treatment of patients with combined oncological and vascular pathology of the brain

The aim of the study were describing the results of surgical treatment of patients with combined oncological and vas‑ cular pathology of the brain and analyzing the scientific literature on the treatment of such combined diseases.Materials and methods. Four patients who underwent surgery for combined oncological and vascular brain pathology in 2020 year in Federal Center for Brain and Neurotechnology and in Sklifosovsky Research Institute of Emergency Care. A review of the literature on the features of the treatment of this category of patients was carried out.Results. Surgery of such combinations is not routine for neurosurgeons; each case deserves special attention. We operated on two patients simultaneously, оne – aneurysm clipping and radiosurgical treatment of the tumor were performed.

The experience of using anti-adhesion gel in the surgery for carpal tunnel syndrome

The study objective is to evaluate the effectiveness of anti‑adhesion gel by using in carpal tunnel syndrome surgery.Materials and methods. A prospective study was carried out among 55 patients with carpal tunnel syndrome. All patients were underwent open decompression of the carpal tunnel. Patients of study group (n = 25) got an carboxymethylcellu‑ lose anti‑adhesion gel, which was applied to the nerve before suturing the wound. Patients from control group (n = 30) were underwent surgery without using an anti‑adhesive gel. Before surgery, all patients underwent a clinical neurological examination with an assessment of symptoms according to the Boston Carpal Tunnel Questionnaire, which includes 2 scales: the scale and the functional status scale. The Boston Carpal Tunnel Questionnaire was reevaluated 2.5 years after surgery.Results. In study group the mean symptom severity decreased by 59.5 %, functional status improved by 55.1 %, in control group these indicators were 48.3 and 47.6 %. Clinical relapse of the disease was noted in 8 % of patients of study group and in 20 % of patients of control group.Conclusion. Intraoperative using of an anti‑adhesion gel allows to reduce the frequency of recurrence of carpal tunnel syndrome after surgical decompression.

A feasible alternative to transfemoral artery access for endovascular revascularization in acute ischemic stroke in cases with difficult vessel anatomy

Endovascular treatment in acute ischemic stroke is usually performed via a transfemoral approach. Catheterization can be problematic in cases with difficult anatomy: unfavorable arch type, vessel tortuosity and ostial stenosis, aorta coarc‑ tation, iliac artery occlusion. The aim of this review is to describe the place of another arterial approach in the manage‑ ment in acute ischemic stroke: direct common carotid

Dostoevsky’s epilepsy

There is a lot of evidence that a great Russian writer and essayist Fyodor Mikhailovich Dostoevsky suffered from epilep‑ sy. Not only this disease had influence on Dostoevsky’s personality and social life, but also affected his creative work. Dostoevsky is believed to suffer from mesiobasal temporal lobe epilepsy with an ecstatic aura – a form named after him afterwards.