5-aminolevulinic acid (5-ALA) is a natural precursor of protoporphyrin IX (PP IX), which possesses fluorescent properties and is more intensively accumulated in tumor cells than in normal tissue. Therefore, the use of 5-ALA in the surgical treatment of intracranial tumors, particularly gliomas, has gained popularity in the last years, whereas its use in other intracranial pathological entities including meningiomas has been reported occasionally. This study describes a series of 28 patients with intracranial meningiomas, who were administered 5-ALA for a better visualization of tumor boundaries. Twelve patients underwent also laser spectroscopic analysis in order to confirm the visual impression of tumor tissue visualization. Bone infiltration was readily demonstrated. In one case, the tumor recurrence could have been prevented by removal of a tumor remnant, which would possibly have been better recognized if spectroscopic analysis had been used. Fluorescent navigation (FN) is a useful method for maximizing the radicality of meningioma surgery, particularly if the tumor infiltrates the bone, the skull base, and/or the surrounding structures
Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.
Meningioma is a well fluorescent tumor, with the technique sensitivity being 94.1%. In some cases, the use of fluorescence diagnostics in surgery of meningiomas improves identification of residual tumor fragments and enables correction of a surgical approach. To assess the effect of fluorescence diagnostics on the recurrence rate and disease-free duration, further research is required.
One of the frequent consequences of severe traumatic brain injury is posttraumatic hydrocephalus that not only hampers the processes of consciousness recovery, rehabilitation, and social adaptation of patients but also is the cause of disability. Pathological processes underlying the clinical picture of posttraumatic hydrocephalus and the relationship between CSF circulation disorders and structural changes in the brain substance have not been adequately studied. Of particular importance are patients in the chronic vegetative or minimally conscious state, recovery from which is blocked by posttraumatic hydrocephalus. The question of reversibility of impaired consciousness depending on the disease duration has remained open. High risks of purulent-inflammatory complications of shunting surgery are especially important in patients with chronic infection foci (tracheostomy, gastrostomy, epicystostomy, prolonged bladder catheterization, pressure ulcers, etc.), but their actual effect on the shunting outcomes has not been revealed. Posttraumatic hydrocephalus remains a topical neurosurgical problem requiring clarification of its diagnostic criteria, differentiation from atrophy-related ventriculomegaly, and comprehensive development of pathogenetic and therapeutic aspects.
РезюмеВ связи с высокой социальной значимостью последствий черепно-мозговой травмы, динамика когнитивных функций на фоне восстано-вительной реконструктивно-пластической хирургии вызывает интерес у исследователей во всем мире, однако данная тема недостаточ-но изучена. Большое число пациентов с костными дефектами черепа вследствие черепно-мозговой травмы и дефектами черепа после оперативных вмешательств по поводу опухолей, и как следствие возможное когнитивное снижение у таких пациентов обуславливает необходимость изучения и оценки возможности его компенсации в результате проведения реконструктивно-пластический хирургии черепа. Материал и методы. В нашей работе проведено нейропсихологическое исследование 54 пациентам (12 женщинам и 42 мужчи-нам), которым выполняли реконструктивно-пластические операции по поводу дефектов черепа (посттравматических или в результате удаления новообразований). Средний возраст пациентов составил 33,1±11,29 лет. Все пациенты были осмотрены медицинским психоло-гом до операции, на первые, третьи, и седьмые/восьмые сутки после ее проведения. Для психологической диагностики использовались шкалы MoCA, FAB, HADS, таблицы Шульте, оценки ситуативной и личностной тревожности по Ч.Д. Спилбергеру -Ю.Л. Ханину, ком-плект стимульных материалов. Всем пациентам предлагалось субъективно оценить их внешность: до получения дефекта, до операции, после проведенного лечения по специально разработанному для нейрохирургических пациентов опроснику [8], так же в исследовании использовался метод проективного рисования, для чего пациентам предлагалось выполнять серии рисунков на заданные темы. Цель исследования -изучить изменения когнитивных функций, уровня депрессии, тревожности у пациентов с послеоперационными костны-ми дефектами черепа после выполнения реконструктивно-пластических операций. Заключение. Полученные данные позволили выявить статистически значимое раннее послеоперационное улучшение когнитивных функций на фоне реконструктивно-пластической хирургии.Получены статистически значимые результаты снижения уровня депрессии, ситуативной и личностной тревожности, улучшения эмо-ционального состояния пациентов после проведенной операции, на фоне ежедневных занятий с психологом при помощи Арт-терапии (проективного рисования).Ключевые слова: когнитивные функции, депрессия, тревожность, реконструктивная хирургия Для цитирования: Синбухова Е.В., Кравчук А.Д., Лубнин А.Ю., Данилов Г.В., Охлопков В.А., Степнова Л.А. ДИНАМИКА КОГНИТИВНЫХ ФУНКЦИЙ У ПАЦИЕНТОВ C ДЕФЕКТАМИ ЧЕРЕПА ПОСЛЕ ПРОВЕДЕНИЯ РЕКОНСТРУКТИВНЫХ ВМЕШАТЕЛЬСТВ. Архивъ внутренней медици-ны. 2017;7(2): 131-138. DOI: 10.20514/22267(2): 131-138. DOI: 10.20514/ -6704-2017 AbstractDue to the high social significance of traumatic brain injury and its consequences, dynamics of cognitive functions at the background of the reduction of reconstructive and plastic surgery is of interest to researchers in the world, but this topic is not sufficiently studied. A large number of patients with bone defects of the skull due to a traumatic brain injury and skull defects a...
Conceptual or systemic approaches to treatment of the traumatic brain injury effects developed by the authors have been reported, which are based on studying the pathogenesis and sanogenesis of the disorder. The use of those has markedly improved the results of treating the skull and brain abnormalities, caused by traumatic brain injury, due the to increased use of the minimally invasive and reconstructive surgery.
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