The storage of dura mater transplants in formalin-containing gel media which allow the entire process of preparation of the biological material to be conducted in non-sterile conditions is substantiated experimentally and clinically. A formalinized allogenous tissue of the same name transplanted in experiments and in the clinic into a defect in the dura mater undergoes active reorganisation and is replaced within a year with a newly-formed connective tissue which does not differ in architectonics from the dura mater of the recipient. When transplants of the dura mater stored in formalin-containing gel media were used in the clinic (172 operations) no complications of the type of liquorrhea, prolapse of the cerebral tissue or coarse subdural adhesions were noted. Suppuration developed in 3 patients (1.7%). The cause of the suppuration, however, was not associated with the transplant. All this makes it possible to recommend allogenous transplants of dura mater stored in formalin-containing gel media for wide use in the practice.
A wide incision of the dura mater of the spinal cord helps to inspect the subdural space in detail. If there is a defect in the dura mater, or if it is impossible to suture it due to edema and swelling of the spinal cord, it is rational to resort to plastic replacement with a band of capron mesh which resolves completely by the end of the third year after the surgical intervention.
A case in which the persisting trigeminal artery is combined with arterial aneurysm is described. This is the 26th case with such combination reported in the world literature and the 4th with combination with an aneurysm of the middle cerebral artery. The arterial aneurysm was manifested by two subarachnoid hemorrhages, and the persisting trigeminal artery only by mild dysfunction of the first branch of the trigeminal nerve. The case described is an additional proof in favour of the theory of the congenital origin of arterial aneurysms of the brain.
On the basis of examination of 130 patients, the authors describe for the first time the thermovision syndromes of cerebral tumors, intracranial hematomas, posttraumatic cranial defects, tumors of the spinal cord, Schmorl' body, injuries to the peripheral nerves, and some other neurosurgical pathologic conditions. The mechanisms of the origin of thermoasymmetry are discussed. The diagnostic possibilities and the prospects of thermovision in neurosurgery are disclosed.
The results of a combined electro-physiological study of cerebral circulation, peripheral circulation and cardiac activity in 100 patients with supratentorial tumors of the brain were examined. Regional-cerebral and systemic hemodynamic disorders increase with the development of intracranial hypertension and in a definite way depend on the histological structure of the new growth and the effect of the median brain structure.
In 5.5% of 126 patients treated for hypophyseal tumors at the Burdenko Institute of Neurosurgery, AMS USSR for 12 months, spread of the new growth to the nasal cavity was revealed. The tumor was usually located in the posterosuperior parts of the nose and was discovered on anterior rhinoscopy only after the nasal mucosa had been carefully anemized, particularly with the use of a nasal dilator with a lamp on its end specially designed by us. Spread of a hypophyseal tumor to the nasal cavity was encountered when the tumor was very large and grew regularly in all directions or when it was marked by selective infrasellarg growth in the direction of the sphenoidal sinus. Cytologic examination of the punctate made it possible to determine the presence of the hypophyseal tumor and its character (benign, malignant) and differentiate it from other new growths and from c.s.p. cysts.
The article discusses the clinical picture, diagnosis, and treatment of a rare pathologic condition of the cerebral vessels known by the Japanese name "moyamoya". Six cases with this disease among adults are described. Three patients had ischemic attacks, two young females were found to have intracerebral hematomas which were successfully evacuated. In one case the vascular anomaly became evident after a craniocerebral trauma and was manifested by subarachnoid hemorrhage and infarction in the subcortical structures.
The article describes a transducer for continuous recording of the readings of a mercury manometer in which, to simplify the construction and calibration, the transducer of pressure changes to electric current changes is made of high-resistant (nichrome) wire passed through the tube of the mercury manometer and incorporated in the circuit of the measuring bridge.
Sixty-seven patients with craniopharyngioma were tested by total (41) or subtotal (26) resection of the tumor. The possibility for radical removal of a craniopharyngioma depends on the size of the tumor and the character of its growth and on the peculiarities of its relation with the abjoining structures, i.e. the sella turcica, third ventricle, optic chiasm, and the vessels of the cerebral base. The tendency to perform radical operations for endosuprasellar craniopharyngiomas may be undertaken if it is possible to achieve atraumatic separation of the capsule of the tumor from the structures forming its seat under the floor of the third ventricle. The results of radical interventions for suprasellar intraventricular craniopharyngiomas are less favourable due to the marked macro- and microstructural changes in the hypothalamic and thalamic parts of the brain.
The functional state of the kidneys and the level of azotemia were studied in 51 patients with a severe craniocerebral trauma. Two groups of patients were distinguished according to the preservation of diminution of glomerular filtration. Comparison between these 2 groups showed that in normal glomerular filtration azotemia was linked with the catabolic process, while in diminished glomerular filtration azotemia was also associated with a reduced renal function. The level of azotemia has been established; a higher value is evidence of renal insufficiency.
The article deals with the results of the quantitative study of the muscular tonus in patients with infantile cerebral paralysis by the method of passive sinusoid movements of the arm at the elbow joint at various rates, with a period of T = Is to T = 200s and its assessment by the value of the mechanical resistance of the extremity in the region of high (T = I--4s) and low rates (T = 50s). The spectromechanomyographic method of examination revealed two components in the muscular tonus: an increase in the region of high rates, which were identify as the spastic component of the muscular tonus, and an increase in the region of low rates, which is identified with the rigid component of the muscular tonus. Operative destruction of the cerebellar dentate nuclei in patients with infantile cerebral paralysis naturally reduces this spastic component, but hardly changes the rigid component. One of the factors causing changes in the shape and amplitude of choreothetoid hyperkinesia in patients with infantile cerebral paralysis may evidently be the redistribution of the tonus in different muscular groups and changes in the correlations between its spastic and rigid components.
Ventriculoscopy is a simple, safe and informative method of examination of the lateral and third ventricles of the brain in childhood. In hydrocephalus of non-tumorous origin ventriculoscopy makes its possible, as a rule, to determine the origin of the dropsy and its character. The diagnosis of tumor of the brain of intraventricular or paraventricular localization and also of a tumor growing into the lumen of a cerebral ventricle is made on the basis of direct and indirect signs found during a visual examination. The histological nature of the process may be determined by biopsy of the pathological tissue collected during ventriculoscopy.
In lumbar peridurography conducted in 117 patients with discogenic radiculitis complications occurred both in the stage of peridural anesthesia and after introduction of the radiocontrast medium. During anesthesia the dura mater was punctured in 4 patients, in another 2 patients dicaine penetrated into the subarachnoid space and caused spinal anesthesia with a high upper level. Peridural anesthesia with paralysis of the respiratory musculature developed in 1 patient. After the injection of the radiocontrast medium, spasm in the lower extremities and trunk of the type of spinal epilepsy developed in 4 patients. The clinical picture, prevention, and treatment of these complications are discussed.
Pressure sustained by the venous valves was studied by means of a self-recording device; 47 valves of the great saphenous veins of the thigh were tests. A total of 51 valves taken from 10 cadavers were studied. The instruments for and the method of ventriculojugulostomy are described. It consists in diverting the CSF from the lateral ventricle of the brain into the internal jugular vein by means of ventricular silicone rubber catheter and a venous auto- or homograft. Despite the severe contingent of patients subjected to surgery, analysis of 12 operations allows the suggested method to be used for treating hydrocephalus both in adults and in children.
An X-ray method of examination of the skull bones is discussed which is used for detecting multiple small perforating defects in the skull of various localization, determination of the localization of foreign bodies in relation to definite anatomical structures, identification of the displacement of the bone fragments into the cranial cavity, and for the diagnosis of multiple infractions of the cerebral skull. Besides two antero-posterior craniograms, radiograms were taken in additional oblique views with the head turned to the right or to the left in the interval of 20 to 45 degrees. The guiding points for the direction of the X-ray heam are: the lateral border of the superciliary arch, the midpoint between the lateral border of the superciciliary arch and the external acoustic meatus, the midpoint between the external acoustic meatus and the external occipital protuberance. The effectiveness of the method was tested on a skull phantom and verified by observations over 3 patients with multiple infractions of the skull bones.
A case with one-stage removal of pus from the cavities of two abscesses in a 49-year-old female through a supratranstentorial approach is described. The postoperative period was uneventful. A follow-up four months later showed that the woman was healthy and continued working.
Neuropsychological analysis of disorders of memory in patients with sacculated aneurysms of the internal carotid arteries, 14 of whom were examined in the immediate and 30 in the remote periods after the hemorrhage, showed that the side of the lesion may be judged by the character of these disorders. The disorders of memory were of a modally-specific character and emerged in the link of direct reproduction in aneurysms of the right internal carotid artery and in the link of delayed (under conditions of interference) reproduction in aneurysms of the left internal carotid artery. The general cerebral signs in the acute stage of subarachnoid hemorrhage are also manifested specifically in the structure of the memory defect.
