This study presents facial nerve neurotization, a common method of surgical treatment of facial muscle paralysis. In this surgical procedure, a trunk or some portions of individual fibers are sewn to an intact nerve-neurotizator to the injured facial nerve that can act as sublingual, masseteric, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the sublingual nerve and anterior branches of the C2C3 cervical spinal nerves. Often, neurosurgeons combine various donor nerves and autotransplanting inserts for better results. The main stages of neurotization of the facial nerve includes isolation and transection of the facial nerve, isolation and transection of the trunk or separate fibers of the neurotizer, and nerve suturing in an end-to-end or end-to-side fashion. Facial cross-plasty, the most innovative method of facial nerve neurotization, should be carefully performed, during which an anastomosis is performed between the damaged and intact facial nerves using autotransplantation inserts from the calf nerve or from a free muscle graft, including a tender muscle and an anterior branch of the locking nerve. Recovery of facial nerve function and regression of characteristic symptoms takes time and specialized recovery treatment. Generally, among the lesions of the cranial nerves, injuries and diseases of the facial nerve rank first and are one of the most common pathologies of the peripheral nervous system. The clinical picture of facial nerve injuries in various origins is quite monotonous and manifested by persistent paralysis or paresis of the facial muscles. Various highly effective techniques are aimed at restoring the function of the facial nerve and facial muscles. Many conservative and operative methods of treating facial nerve neuropathy have been presented in the modern medical literature. However, all methods of facial nerve neurotization have several disadvantages, and the leading ones are the inability to achieve 100% efficiency and development of one degree or another neurological deficit.
Pathologies of the facial nerve are one of the most common types of pathology of the peripheral nervous system. In the structure of lesions of the cranial nerves, this pathology occupies the first place. The clinical picture of facial nerve damage of various genesis is rather monotonous and manifests itself as persistent paresis or paralysis of the facial muscles. The literature describes a large number of different highly effective techniques aimed at restoring the function of the facial nerve and mimic muscles, examples of which are numerous conservative and surgical methods for the treatment of facial nerve neuropathy. The review presents the most common method of mimic muscles paralysis surgical treatment facial nerve neurotization. The essence of this surgical intervention is in suturing to the affected facial nerve the trunk or a portion of individual fibers of the intact nerve-neurotic, which can be the hypoglossal, masticatory, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the hypoglossal nerve and the anterior branches of the C2C3 cervical nerves. Currently, options for the combined use of various donor nerves and autoextensions are gaining popularity among neurosurgeons, due to more favorable results in restoring the function of the facial nerve, as well as with an individual approach to each patient. The main stages of neurotization of the facial nerve include the isolation and intersection of the facial nerve, the isolation and intersection of the trunk or individual fibers of the neurotizer, the execution of the suture of the nerve in the end to end or end to side method. Particular attention should be paid to the most innovative method of facial nerve neurotization facial nerve cross-plasty, during which an anastomosis between the damaged and intact facial nerves using autotransplants from the gastrocnemius nerve or a free muscle graft, including the tender muscle and the anterior branch of the obturator nerve is performed. The process of restoring facial nerve function and regressing characteristic symptoms takes a long period of time and requires specialized restorative treatment.
Morphoscopic and morphometric characteristics of the LIVLV intervertebral disc were assessed according to magnetic resonance images of the lumbar spine of 90 patients (66 men, 24 women). The morphometric parameters of the LIVLV intervertebral disc and nucleus pulposus were compared between young (1844 years old) and middle-aged (4560 years old) adults and in groups determined by sex and body type. In addition, morphoscopic characteristics, namely, the shape of the intervertebral disc and nucleus pulposus in the axial plane, were evaluated. Results. In normal intervertebral disc, LIVLV on the axial section most often presents in a kidney-shaped (51%), elliptical (45%), and round (4%) form. The LIVLV nucleus pulposus normally has an oval (50%), kidney (45%), and less often a lemniscate (5%) shape. The shape and individual morphometric parameters of the intervertebral disc and nucleus pulposus of the LIVLV segment have significant sex differences. Thus, the most lateral height of the intervertebral disc on the right and left, anteroposterior size and area of the intervertebral disc, and anteroposterior size, width, and area of the nucleus pulposus are significantly larger in men than in women. When assessing the influence of body type on intervertebral disc structural features, no significant differences in its shape were found between asthenics, normo- and hypersthenics, while individual dimensions (intervertebral disc height in the center and its dorsal height) were significantly larger in hypersthenics. The kidney-shaped form of the nucleus pulposus was significantly more common in asthenics and the oval form in hypersthenics, whereas the morphometric parameters of the nucleus pulposus did not significantly differ between extreme body types. Statistically significant differences in the shape of the nucleus pulposus were found between age groups. The results of the analysis of morphometric characteristics revealed the intervertebral disc height tended to decrease in middle-aged people compared with young people. The results can be used in planning spine surgery and designing artificial intervertebral discs.
Objective: to study the morphoscopic and morphometric characteristics of the LV-SI intervertebral disc according to magnetic resonance imaging. Materials and methods. The analysis of magnetic resonance imaging of 90 patients (66 men, 24 women) who did not have diseases of the lumbar spine was performed. Various morphometric parameters of the intervertebral disc (IVD) and nucleus pulposus (NP) at the LV-SI level were measured using software for processing images created on an MRI machine. The obtained data were compared between men and women, asthenics, normosthenics, hypersthenics and young (from 18 to 44 years old) and middle-aged (from 45 to 60 years old) people. In addition, morphoscopic characteristics were studied: the shape of the IVD and NP in the axial plane. Results. It was found that in normal IVD LV-SI is most often represented by elliptical (54,5%) less often kidney-shaped (45,5%) forms. Normally, the NP has an oval (57,8%) and kidney-shaped (42,2%) shape. It was shown that in men, the dorsal height of the IVD, its width, anteroposterior size, square as well as the longitudinal-transverse index of the NP were significantly higher. It has been proven that there are no significant differences in the shape of the IVD between asthenics, normo- and hypersthenics, while the height of the IVD in the center, its ventral, dorsal heights and most lateral IVD height are significantly greater in hypersthenics. It has been proved that the kidney-shaped form of NP was significantly more common in asthenics, and the oval form - in hypersthenics, while the morphometric parameters of NP did not significantly differ between extreme body types. A tendency to a decrease in IVD height in middle-aged people compared to young people was shown. Conclusion. The results obtained are necessary when planning the operation, as well as for the manufacture of rigid implants and artificial discs for arthroplasty and interbody fusion.
The possibility of morphometric variability of parameters and variant anatomy of the sphenoid sinus at different age periods in children and adolescents was considered based on computed tomography data. Further, 425 computer tomograms of the head area of children and young people between the ages of 1 and 21 years, regardless of sex, were studied. According to the accepted age periodization, the studied material was divided into six age periods. The development of pneumatization of the sinuses is detected at the age of 11.5 years and continues in adolescence. The shape of the sinuses changes with age accordingly with increase in its pneumatization: in 11.5 and 23 years, the sphenoid sinus has only a precellular shape and in adolescence, the post-cellular shape prevails. The linear parameters of sphenoid sinus are minimal at 11.5 years (height, 1.7 mm; width, 1.7 mm; length, 1,3 mm) and 23 years (height, 6.7 mm; width, 5 mm; length, 5.1 mm). The sinus significantly grows in all directions at age 47. Hyperpneumatization of sphenoid sinuses with formation of side pockets is defined from 47 years in four variants: 1, maxillary; 2, lower-sided; 3, rostral; and 4, wing-shaped. In adolescence, there are all pockets of sphenoid sinuses, which are described in the manuals. The frequency of occurrence of intra-sinus septum increases with age; in almost all cases, incomplete bone intra-sinus septum is found. Onodi cells are found in almost each age group; their presence does not depend on the age of the child. If they are present, the spread of pneumatization of the lattice maze into adjacent surrounding anatomical structures is noted. When planning endonasal surgery on the sphenoid sinus in children and adolescents, the morphometric anatomy of the nasal cavity, variant anatomy of the structure of the sphenoid sinuses, and nearby structures of the inner base of the skull should be studied in detail.
ель исследования. Оценить возможности и определить диагностическую эффективность ультразвукового исследования при травматических повре-ждениях периферических нервов конечностей. Материалы и методы. В исследование включено 154 пациента с посттрав-матической невропатией периферических нервов конечностей. Всем больным выпол-нено ультразвуковое исследование на аппаратах экспертного класса линейными датчи-ками с диапазоном частот от 5 до 15 МГц. Для оценки эффективности ультразвукового исследования использовался статистический анализ чувствительности, специфичности и точности, проводившийся по методике качественной оценки референтного (опера-тивное вмешательство или положительное консервативное лечение) и изучаемого мето-да (ультразвуковое исследование).Результаты и обсуждение. Установлено, что использование ультразвукового исследования является эффективным методом диагностики при повреждениях пери-ферических нервов конечностей, позволяет в полном объѐме оценить локализацию и характер повреждения, а также определиться с дальнейшей тактикой лечения. По ре-зультатам ультразвукового исследования 122 пациента были прооперированы, консер-вативное лечение проведено 32 больным. После проведения сравнительного анализа данных дооперационного УЗИ с выявленными изменениями в процессе оперативного вмешательства, а также с результатами консервативного лечения была определена диа-гностическая эффективность ультразвукового исследования при повреждениях пери-ферических нервов конечностей.Выводы. Ультразвуковое исследование с точностью 86,4% позволяет, как вы-явить повреждения, при которых всегда показано оперативное лечение, так и подтвер-дить анатомическую целостность нервного ствола, при которой травма является обра-тимой и операция не показана.Ключевые слова: хирургия периферических нервов, ультразвуковое исследова-ние нервных стволов, диагностика и лечение повреждений нервов.Контактный автор: Журбин Е.А.,
A clinical example of surgical treatment of a patient with long-term consequences of a gunshot blind non-penetrating wound of the lumbar spine received 15 years ago is presented. The indication for performing surgical intervention was the development of recurrent retroperitoneal phlegmon in the last year and a half against the background of the presence of a foreign body (bullet) in the interbody gap L1–L2. In the “cold” period of the inflammatory process, the least invasive operation was performed. The article describes the course of percutaneous transforaminal endoscopic removal of a foreign body, and demonstrates the possibilities of such access. The above clinical observation indicates that the method of percutaneous transforaminal endoscopic surgery may not be limited in its indications only to degenerative-dystrophic diseases of the spine.
Военно-медицинская академия им. С. м. Кирова, Санкт-петербург, Российская Федерация 2 Санкт-петербургский государственный университет, Российская Федерация 3 Национальный медицинский исследовательский центр им. В. А. Алмазова, Санкт-петербург, Российская Федерация regional feaTures of The inTernal VerTeBral Venous pleXus gaivoronsky i. V. 1, 2 , rodionov a. a. 2 , Bulyshchenko g. g. 1 , nichiporuk g. i. 1, 2 , gaivoronskaya m. g. 2, 3 , gaivoronsky a. i. 1, 2 1 s. m. Kirov military medical academy, st. petersburg, russian federation 2 st. petersburg state university, russian federation 3 V. a. almazov national medical research center, st. petersburg, russian federation На 32 препаратах позвоночного столба взрослых людей II периода зрелого возраста с применением инъекционных и коррозионных методик, стереоэпидуроскопии и пироговских срезов изучено венозное русло эпидурального пространства. Представлена топографическая анатомия внутреннего позвоночного венозного сплетения и особенности его строения в разных отделах позвоночного канала. Выделены магистральная, смешанная и сетевидная формы изученного сплетения. Приведены данные об изменениях площади поперечного сечения внутреннего позвоночного венозного сплетения в кранио-каудальном направлении. Рассмотрены структурно-функциональные характеристики венозного сплетения, его взаимоотношения с соединительнотканными структурами эпидурального пространства и их прикладное клиническое значение. Для предупреждения возможных осложнений во время выполнения различных врачебных манипуляций представлены данные об аваскулярных зонах эпидурального пространства. Исходя из анатомических особенностей топографии дугообразных анастомозов задних продольных вен внутреннего позвоночного сплетения, в разных отделах выделены зоны, манипуляции в которых можно проводить с большой степенью осторожности: опасной зоной является уровень С I-VII , Th I-XII ; зоной относительной безопасности-уровень L I-L V ; безопасной-зона S IS IV. Ключевые слова: вариантная анатомия, внутреннее позвоночное венозное сплетение, коррозионный препарат, позвоночный канал, позвоночный столб, эпидуральное пространство The venous bed of the epidural space was studied in 32 preparations of the vertebral column of adults of the II period of adulthood using injection and corrosion techniques, stereoepiduroscopy and Pirogov sections. The topographic anatomy of the internal vertebral venous plexus and the features of its structure in different parts of the spinal canal are presented. The main, mixed, and reticular forms of the studied plexus are distinguished. Data on changes in the cross-sectional area of the internal vertebral venous plexus in the cranio-caudal direction are presented. The structural and functional characteristics of the venous plexus, its relationship with connective tissue structures of the epidural space and their practical significance are considered. To prevent possible complications of various medical procedures, data on avascular zones of the epidural space are presented. Based on the anatomical featur...
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