In the article a rare case of abnormal anatomical structure of the median nerve in a patient with carpal tunnel syndrome is described: a high bifurcation of the median nerve. A 67-year-old woman complained of periodic intense nocturnal pain and numbness of 1-3 fingers of her left hand. During clinical examination Phalen’s wrist flexion and wrist extension tests, Hoffmann-Tinel, postural provocation, median nerve compression, and the “tourniquet” tests were positive. Allen's test was negative. There was no atrophy of the thenar muscles, the strength of palmar abduction of the thumb was comparable to that of the right hand. Sensitivity of the fingers was unchanged. Based on the history and clinical examination, a diagnosis of idiopathic carpal tunnel syndrome of the left hand was made. Open carpal tunnel release, mesoepineurolysis of the median nerve, and tenosynovectomy were performed. Intraoperatively, it was found that from the proximal edge of the wound, the trunk of the median nerve was split into two parts, which were reconnected in the area of the exit from the carpal tunnel, forming a “loop” like structure. An hourglass deformity was also noted on both branches of the median nerve. The radial branch of the split nerve was visually thicker than the ulnar branch. Postoperatively, pain and numbness of 1-3 fingers resolved completely. The median nerve bifurcation is extremely difficult to detect preoperatively. In the case of a traumatic complete anatomical injury to the median nerve, one should make sure that this structural anomaly is absent, and if there is a bifurcation of the nerve, an extended revision should be performed and a suture should be placed on both damaged branches. During surgical treatment of carpal tunnel syndrome, it is advisable to check whether the bifurcated nerve runs through a single canal rather than two separate canals. In the latter case, it is necessary to influence both canals during operative or conservative treatment.
Acute ischemic stroke is a medical emergency in which every minute of delay results in irreversible loss of brain tissue. The main treatment modalities—intravenous thrombolysis and endovascular thrombectomy—have strict time windows and depend critically on the accuracy of neuroimaging. Conventional image interpretation requires substantial clinical expertise, is time-consuming, and is subject to interobserver variability. Modern artificial intelligence (AI) algorithms open new opportunities for the automated detection of vascular occlusions, assessment of ischemic core volume, and generation of real-time treatment recommendations. The application of these algorithms can significantly reduce the time from patient admission to the initiation of reperfusion therapy, improve the accuracy of patient selection, and standardize clinical decision-making. Objective: To summarize current evidence on the role of AI algorithms in decision-making for thrombolysis and thrombectomy and to assess their potential to improve the speed and accuracy of patient selection. Materials and methods: A literature review (2015–2025) was conducted using the PubMed, Scopus, Web of Science, and Google Scholar databases with the keywords “artificial intelligence,” “machine learning,” “deep learning,” “stroke,” “thrombolysis,” and “thrombectomy” to synthesize contemporary data on the use of AI algorithms in clinical decision-making for acute ischemic stroke. Clinical studies, reviews, and protocols describing the application of AI in neuroimaging, prognostication, and patient stratification were analyzed. Results: Deep learning algorithms (e.g., Viz.ai, e-ASPECTS) enable automated processing of computed tomography and magnetic resonance imaging, rapidly identifying ischemic lesions and vascular occlusions. This reduces the time from diagnosis to treatment by 15–37 minutes, improves the reproducibility of assessments, and optimizes patient selection for reperfusion therapy. Models integrating clinical and neuroimaging data demonstrate superior predictive accuracy and allow consideration of individual patient characteristics. Conclusions: Artificial intelligence is becoming an integral tool in stroke management by providing rapid, standardized, and objective data analysis. Its implementation reduces “door-to-needle” and “door-to-puncture” times, improves treatment outcomes, and decreases disability. The synergy between clinicians and AI heralds a new era of personalized stroke therapy aimed at preserving brain tissue and saving patients’ lives.
Background: Traumatic brain injury (TBI) remains a major clinical challenge in neurosurgery due to its heterogeneous pathophysiology and the limited availability of effective pharmacological interventions. Progesterone and vitamin D have demonstrated neuroprotective and anti-inflammatory properties in preclinical models; however, their translational efficacy in clinical trials remains inconclusive. Clarifying their therapeutic roles may help inform adjunctive strategies in the acute management of neurotrauma. Objectives: To assess the neuroprotective effects of progesterone and vitamin D in enhancing functional recovery following moderate to severe TBI, and to compare the clinical efficacy of these agents based on standardized neurological outcome measures derived from randomized controlled trials (RCTs). Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Randomized controlled trials (RCTs) were identified through searches of PubMed, EMBASE, Web of Science, and the Cochrane Library, comparing progesterone and/or vitamin D with placebo in patients with traumatic brain injury (TBI). Studies reporting Glasgow Outcome Scale–Extended (GOS-E) outcomes were included. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using Review Manager version 5.4. Study quality and heterogeneity were assessed. Results: Six RCTs were included: three progesterone trials (n = 1,426) and three vitamin D trials (n = 192). Progesterone showed no significant improvement in functional outcomes compared with placebo (SMD = −0.07; 95% CI: −0.32 to 0.19; p = 0.60; I² = 58%). Vitamin D demonstrated a non-significant trend toward improved outcomes (SMD = 0.37; 95% CI: −0.27 to 1.02; p = 0.26; I² = 78%). Variability in trial design, timing of intervention, and baseline vitamin D deficiency status may have influenced the observed effects. Conclusions: Although neither agent showed standalone efficacy, their safety and complementary mechanisms suggest promise for combinatorial or biomarker-guided approaches. This meta-analysis highlights the need for early, precision-targeted, and stratified neuroprotective trials in TBI care.
Blast trauma is one of the most challenging problems in modern ophthalmology and neurology, as it is often accompanied by severe injuries of the visual system. According to various authors, ocular involvement accounts for up to 28% of all blast-related injuries. Traumatic brain injury (TBI), which frequently coexists with blast trauma, is complicated by ophthalmic disorders in 84% of cases. This highlights the exceptional vulnerability of the eye to blast-related factors — shock wave, thermal effects, and fragments. The most common injuries include open globe trauma, intraocular foreign bodies, globe rupture, retinal detachment, and traumatic optic neuropathy. Secondary factors (shrapnel, building debris, soil, metal) markedly increase the risk of severe complications such as endophthalmitis, post-traumatic glaucoma, and retinal neovascularization, which often lead to disability. Diagnosis requires a comprehensive approach involving ophthalmological methods (ophthalmoscopy, ultrasound, optical coherence tomography), neurophysiological techniques (visual evoked potentials, electroretinography), and neuroimaging (CT/MRI of the orbits and brain). Their combination enables detection of both local ocular damage and central visual pathway impairment. Treatment includes emergency surgery (globe repair, removal of foreign bodies, vitreoretinal interventions), infection prophylaxis (systemic and local antibiotic therapy), as well as anti-inflammatory and immunomodulatory therapy. Timely prevention of sympathetic ophthalmia is of particular importance. Further rehabilitation involves restorative and functional methods aimed at preserving residual vision and improving patient adaptation. Thus, blast-related injury of the visual analyzer is characterized by multifactorial mechanisms and a high risk of permanent vision loss. Optimal diagnosis and treatment are possible only through a comprehensive multidisciplinary approach with an emphasis on early intervention and long-term rehabilitation.
Objective: To develop, theoretically substantiate, and perform primary validation of a multilevel (0–10 points) scale for quantitative assessment of the intensity of external mechanical impact in traumatic spinal injuries. Materials and methods: The study design followed the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) principles for developing and validating medical measurement tools, ensuring an adequate level of scientific validity and reproducibility. A literature review (PubMed, Scopus, Web of Science, 1990–2025) enabled the identification of threshold values and modifying factors, including patient body mass, the transmission coefficient of impulse (Tland))), and the effective deceleration distance (Sland). Two datasets were used for validation: 40 standardized clinical vignettes and 52 real cases of thoracolumbar junction trauma (Th11–L2) with mandatory verification by computed tomography/magnetic resonance imaging. Construct and criterion validity, inter-rater reliability (ICC, κ), absolute reliability (SEM, MDC95), diagnostic accuracy (ROC analysis), agreement level (Bland–Altman), and threshold stability were assessed. Results: Based on comparative analysis of various approaches, the concept of “equivalent fall height” was proposed as a universal criterion of mechanical exposure in spinal trauma. An 11-level (0–10) quantitative scale and a spine-oriented derived metric were developed. Primary validation demonstrated high inter-rater agreement (ICC(2,1): 0.84 for the basic indicator and 0.79 for the spinal-oriented one; ICC(2,k): 0.95 and 0.92), acceptable absolute precision (SEM 0.80–0.95; MDC95 2.2–2.6 points), and stable thresholds (discrepancies exceeding ±1 level occurred in <7% of cases). The metrics showed significant associations with vertebral body wedge deformity (r=0.58), spinal canal compromise (r=0.49), and ordinal injury severity by AO Spine (ρ=0.62; p<0.001). In logistic modeling, each additional 1 m in equivalent fall height nearly doubled the odds of burst/unstable injuries (OR=1.85; 95% CI 1.45–2.38). The diagnostic performance of the scale was confirmed (AUC=0.82) for identifying vertebral fractures (optimal threshold ≈1.3 m; sensitivity – 0.76; specificity – 0.72). Conclusions: The proposed scale provides a quantitative, mass-neutral, and clinically interpretable measure of the “event severity,” complements morphological classifications, enhances risk stratification, and can be applied for patient triage, diagnostic planning, and multicenter research.
Objective: To develop a stage-based treatment algorithm for pain syndrome in patients with warfare injuries to the peripheral nerves of the extremities and to determine the optimal timing for surgical intervention on peripheral nerves through analysis of the literature and our own clinical data. Materials and methods: Pain management outcomes were analyzed in 1,053 patients with peripheral nerve injuries sustained during warfare. All patients underwent clinical and ultrasonographic examination, and pain intensity was assessed using the Visual Analogue Scale (VAS). Patients were divided into two treatment groups: primary conservative treatment and primary surgical treatment. The primary conservative treatment group included 265 patients who were managed using conservative methods (pharmacotherapy, nerve hydrodissection, administration of steroid anti-inflammatory agents, platelet-rich plasma injections, or botulinum toxin). The primary surgical treatment group comprised 788 patients with warfare injuries to the peripheral nerves of the extremities who required surgical nerve repair, including patients with painful neuromas after limb amputations. Pain intensity (VAS) was reassessed at 1, 3, 6, and 12 months after treatment. Results: Conservative treatment demonstrated satisfactory outcomes in cases of mild pain syndrome with maintained positive dynamics during the first month from treatment initiation. Surgical treatment of warfare injuries to peripheral nerves resulted in a stable and predictable effect in the majority of cases. However, in the long-term follow-up period, some patients experienced worsening of regenerative pain during skeletal muscle reinnervation. Patients with painful neuromas represented the most challenging subgroup, as pain in these cases was typically chronic and difficult to manage. Conclusions: Patients with warfare injuries to the peripheral nerves of the extremities should undergo ultrasound examination. In the absence of nerve compression or irritation and with preserved anatomical continuity, treatment should begin with pharmacotherapy; if necessary, nerve hydrodissection or injection therapy with steroids or botulinum toxin may be performed. In cases of significant compression, nerve disruption, or lack of effect after conservative treatment within 6 weeks, surgical intervention is recommended.
Background: Postoperative seizures are a recognized complication following decompressive craniectomy (DC); the global research landscape regarding seizure detection in this context remains insufficiently characterized. Bibliometric mapping provides insights into emerging trends and knowledge gaps. Objective: This study aims to map and evaluate international research output on seizure detection in critically ill patients after decompressive craniectomy. Methods: Relevant literature was collected from Scopus, PubMed, CrossRef, and Google Scholar using the terms ‘decompressive craniectomy AND seizure AND detected’ via the Publish or Perish software. Records were exported in RIS format and analysed with VOSviewer to generate keyword co-occurrence networks, cluster maps, and temporal trend visualizations. Results: A total of 1,605 publications from 2015–2025 were analyzed. Annual research volume increased, particularly since 2018. The co-occurrence network analysis identified four thematic clusters: (1) clinical outcomes and prognosis, (2) surgical techniques and perioperative management, (3) intracranial pressure and monitoring strategies, and (4) seizure detection and critical neurological care. Overlay analysis revealed a gradual thematic shift toward seizure monitoring and electroencephalography EEG-based approaches in recent years, while density visualization confirmed that seizure detection remains an emerging but relatively underdeveloped research area. The most prolific contributor was identified with 126 publications. Conclusion: Although publications on decompressive craniectomy have grown rapidly, seizure detection remains a relatively small but growing research topic. Increased focus on neurocritical monitoring indicates future opportunities for developing evidence-based protocols and collaborative studies in this field.
Introduction: Vestibular schwannoma (VS) adversely affects patients’ functional status and quality of life (QoL). Disease-specific questionnaires, such as PANQOL and Mayo VSQOL, provide a more sensitive assessment of disease progression and treatment outcomes compared with general instruments. Modern microsurgical techniques aim to preserve facial and cochlear nerve function, which directly influences postoperative QoL. Objective: To evaluate the QoL of patients with VS using the Ukrainian versions of PANQOL and Mayo VSQOL questionnaires and to validate them according to COSMIN standards. Materials and methods: The prospective study included 190 patients with VS, divided into three groups: Group I (n=64) — traditional microsurgery (2001–2016); Group II (n=57) — modern microsurgical techniques (2017–2024); Group III (n=69) — observation (“wait-and-scan”). QoL was assessed using PANQOL, Mayo VSQOL, SF-36, QLQ-C30, and BN20 questionnaires. Correlation analysis was performed; statistical significance was set at p<0.05. Results: Mayo VSQOL scores were significantly higher in Group II compared with Group I in the domains of balance (+33.3%), tinnitus/pain (+36.4%), emotional well-being (+43.1%), memory (+58.4%), and total score (+32.2%). Comparison with Group III also confirmed the advantage of surgical treatment, particularly in emotional well-being and memory (+44.3%). PANQOL demonstrated the greatest improvement in the “Face” domain (+35.6%), while changes in other domains were not statistically significant. Significant correlations were found between PANQOL and Mayo VSQOL results with SF-36, QLQ-C30, and BN20, confirming their validity. Internal consistency was high (PANQOL α=0.75–0.93 preoperatively; α=0.81–0.90 postoperatively; Mayo α=0.763–0.938 preoperatively; α=0.858–0.937 postoperatively). Test–retest reliability (ICC) ranged from 0.60–0.91 for PANQOL and 0.778–0.953 for Mayo. Mayo VSQOL demonstrated higher responsiveness to clinical changes (Cohen’s d=2.11; SRM=1.74) compared with PANQOL (Cohen’s d=0.87; SRM=0.75). Conclusions: PANQOL and Mayo VSQOL are reliable instruments for assessing QoL in patients with VS. Mayo VSQOL demonstrated higher sensitivity, while PANQOL showed stable correlation with general QoL scales. The use of modern microsurgical techniques substantially improves postoperative QoL in VS patients.
Background: Spondylolisthesis, or anterior vertebral displacement, is a complex spinal disorder characterized by diverse symptoms and various treatment approaches. Transforaminal Lumbar Interbody Fusion (TLIF) is increasingly preferred over Posterior Lumbar Interbody Fusion (PLIF); however regional data in India are limited. Objective: This prospective study evaluated clinical, radiological, and functional outcomes after TLIF in lumbar spondylolisthesis patients treated at a tertiary center in central India. Methods: Fifty adult patients with Grade II–IV lumbar spondylolisthesis underwent TLIF. Assessments included pain (Visual Analogue Scale, VAS), disability (Oswestry Disability Index, ODI), neurological status, slip angle correction, fusion rates, and complications pre- and postoperatively. Statistical significance was set at p < 0.05. Results: Locations L4–L5 (56%) and L5–S1 (44%) were the affected levels. The mean preoperative VAS and ODI scores were 7.4±1.0 and 74±10%. At 6 months follow-up, VAS decreased by 71.6% to 2.1, and ODI by 88% to 9.5% (p < 0.001). Neurological recovery included full motor deficit resolution and 92% sensory improvement. The mean slip angle correction was 14.6±5.3°, and the fusion success rate was 92%. Complications were minimal, including 4% wound infection and 4% transient neurological deficits, with no implant failures. Conclusion: TLIF shows excellent short-term results, offering substantial pain relief, functional and neurological recovery, and high fusion rates in Indian patients with moderate-to-severe spondylolisthesis. Further studies with larger sample sizes and longer follow-up periods are warranted to validate these findings.
This paper presents current data on the clinical features, diagnosis, and treatment of post-concussion syndrome (PCS) that develops after mild blast-related traumatic brain injury (mbTBI). It is emphasized that PCS is one of the most common long-term consequences of mbTBI among military personnel exposed to blast waves, which determines the clinical and social relevance of this problem. The diagnostic criteria for PCS according to the International Statistical Classification of Diseases, 10th Revision (ICD-10), and the Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV), are described, as well as the difficulty of differentiating PCS from post-traumatic stress disorder, which frequently co-occurs with PCS in combat veterans. The following symptom groups are identified: cognitive, psychoemotional, somatosensory, autonomic, and vestibular. Particular emphasis is placed on the importance of using neurophysiological methods—quantitative electroencephalography and P300 event-related potentials—to objectify the diagnosis of PCS. The therapeutic approach should be multidisciplinary and personalized, incorporating physical rehabilitation, cognitive-behavioral therapy, sleep hygiene, and pharmacological management (antidepressants, analgesics, botulinum toxin therapy, and hyperbaric oxygen therapy). Research findings indicate the importance of early physical activity.
Objective: To evaluate the effectiveness of middle meningeal artery embolization (MMAe) in patients with chronic subdural hematoma (cSDH) based on the first 19 clinical cases performed at Mechnikov Dnipropetrovsk Regional Clinical Hospital. To clarify the indications for isolated versus combined treatment of cSDH and to assess the feasibility of the transradial approach. Materials and methods: A retrospective cohort study was conducted based on the analysis of prospectively collected data from patients with chronic subdural hematomas who underwent MMAe at I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital between March 24, 2022, and November 6, 2024. The study included 19 patients who underwent endovascular intervention, either as a standalone procedure or in combination with open surgery. Demographic data, etiological factors, clinical presentation, CT, MRI, and DSA findings were analyzed. Treatment effectiveness was assessed at 1, 3, and 6 months postoperatively. Results: According to the type of treatment, patients were divided into 3 groups: isolated MMAe — 13 patients (68.4%); primary MMAe followed by surgical drainage — 3 patients (15.8%); primary surgical evacuation followed by MMAE — 3 patients (15.8%). Traumatic cSDH was diagnosed in 12 patients (63.2%), while spontaneous cSDH occurred in 7 patients (36.8%), including two cases with mycotic aneurysms of cortical Middle Cerebral Artery (MCA) branches, which were managed with endovascular deconstructive exclusion and subsequent MMAe. One patient with chronic anemia underwent isolated MMAe. Among all patients, 5 (26.3%) were on anticoagulant/antiplatelet therapy, and hemodynamically significant carotid stenosis was identified in 3 patients (15.8%). Follow-up imaging (CT, MRI) at 6 months demonstrated clinical improvement in 100% of cases, with complete hematoma resolution in 17 patients (89.5%). Conclusions: MMAe has proven to be highly effective and safe in the management of cSDH, both as a stand-alone method and as an adjunct to conventional surgery. The transradial approach demonstrated advantages in elderly and high-risk patients, contributing to reduced hospitalization times. Furthermore, the use of OnyxTM ensured deeper penetration and more durable occlusion of pathological vessels compared to polyvinyl alcohol (PVA) particles. These findings are consistent with current global trends and confirm the promising role of MMAe in cSDH treatment.
Introduction: Giant parasagittal and falcine meningiomas are surgically challenging due to their frequent involvement of the superior sagittal sinus (SSS), proximity to eloquent cortex, and complex venous anatomy. Although these tumors carry a high operative risk, detailed analyses of surgical difficulty remain limited in the literature. Objective: This narrative review of published case reports and series aims to delineate the key determinants of surgical complexity in giant parasagittal and falcine meningiomas, including tumor size, sinus involvement, anatomical constraints, and intraoperative decision-making while emphasizing the balance between surgical radicality and patient safety. Methods: A narrative review and multicase synthesis were performed, analyzing 22 published reports (19 case reports and 3 case series) describing the microsurgical management of giant parasagittal and falcine meningiomas. Studies were included based on the PICOS framework, focusing on tumors ≥5 cm with original surgical and outcome data. Extracted variables included demographics, tumor size, location, SSS involvement, histology, surgical technique, and clinical outcomes. Results: A total of 36 patients were identified. Most tumors were parasagittal (52.8%), involved the middle third of the SSS (38.9%), and demonstrated SSS invasion (78.6%), with complete occlusion in 64.3% of cases. Gross total resection was achieved in 75.7% of cases. Pediatric patients (11.1%) were more frequently associated with high-grade histology and intraoperative complications. Tumors involving the middle third of the SSS and those with parasagittal location were consistently associated with increased technical difficulty, venous bleeding, and postoperative deficits. Overall, 72.2% of patients experienced favorable recovery, while 11.1% had poor outcomes, including tumor recurrence or death. Conclusion: Surgical management of giant parasagittal and falcine meningiomas is technically demanding, particularly in pediatric cases and when tumors involve the parasagittal region or the middle third of the SSS. Careful preoperative venous evaluation and individualized strategies are crucial for optimizing the resection while minimizing complications.
Objective: To optimize the selection of surgical treatment strategy for patients with lumbar and lumbosacral disc herniation by performing a comparative analysis of the outcomes of microdiscectomy and microdiscectomy with interbody cage fusion in order to improve treatment results. Materials and methods: The study included 200 patients with lumbar and lumbosacral disc herniation treated at the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine between 2015 and 2022. Neurological status was assessed based on the severity of pain syndrome, the presence of segmental instability was determined. Magnetic resonance imaging, computed tomography, and radiographic findings were evaluated. The following surgical techniques were used: microdiscectomy for lumbar and lumbosacral disc herniation. Results: Microdiscectomy with interbody cage fusion eliminated manifestations of instability and provided more effective stabilization of the lumbosacral spine compared with microdiscectomy alone. The recurrence rate of disc herniation after microdiscectomy with cage fusion lower (3%) compared with microdiscectomy alone (9%). In the group treated with microdiscectomy and cage fusion, a more pronounced reduction in pain intensity (–82%) and a greater decrease in the Oswestry Disability Index (–81%) were observed, indicating higher effectiveness of the stabilization technique. According to the Macnab and Prolo scales, excellent and good outcomes were recorded more frequently in the microdiscectomy with cage fusion group than in the microdiscectomy group (91% vs 78% and 91% vs. 77%, respectively). The Wilcoxon test confirmed a high level of within-group improvement (p<0.001), while the t-test demonstrated statistically significant differences between the groups. Conclusions: The lumbosacral segment with an implanted cage is more stable and withstands greater mechanical loads during motion, reduces the recurrence rate of disc herniation, and decreases pain severity. Microdiscectomy with interbody cage fusion may be considered in carefully selected patients with signs of segmental instability as an approach that combines decompression and stabilization and is associated with better long-term clinical outcomes.
This prospective observational study was done to evaluate the outcomes and management of patients with degenerative cervical myelopathy (DCM) treated with anterior cervical discectomy and fusion (ACDF). Materials and methods: Our study included 80 patients with DCM admitted to a neurosurgical department between August 2013 and February 2023. Patients underwent ACDF surgery for single- or multi-level spinal canal stenosis. Demographic data, clinical features, and neurological examinations including assessments of limb power using the Medical Research Council Scale, sensory system function, and sphincter disturbance pre- and post-operatively were assessed. Pre- and post-operative neurological function was evaluated using the Nurick score, while post-operative outcomes were assessed using the Odom's criteria. The study population consisted mainly of males aged 51-60 years. Myelopathy was the most frequent presentation, with C5-C6 level being the most common level of fusion. Results: ACDF surgery significantly improved neurological function, as evidenced by reduced pre-operative weakness and sensory dysfunction, and increased post-operative muscle strength. Minimal postoperative complications were observed. Conclusions: These findings align with previous research, demonstrating ACDF as a safe and effective procedure for improving neurological function and quality of life in DCM patients. Limitations include sample size and study design, necessitating further research.
Suprasellar arachnoid cysts are rare entities, accounting for approximately 20% of all intracranial arachnoid cysts. Objective: To evaluate the efficacy of endoscopic ventriculocystostomy and endoscopic ventriculocystocisternostomy in the treatmentof children with suprasellar arachnoid cysts. Materials and Methods: Between 2016 and 2023, 29 children with suprasellar arachnoid cysts were treated at the Romodanov Institute of Neurosurgery, National Academy of Medical Sciences of Ukraine. The cohort included 18 boys (62%) and 11 girls (38%), with ages ranging from 4 months to 17 years (mean age – 2.8 years). Depending on the surgical technique used, patients were divided into two groups: Group 1 (n=19) underwent endoscopic ventriculocystostomy, and Group 2 (n=10) underwent endoscopic ventriculocystocisternostomy. Results: The effectiveness of both procedures was confirmed by clinical and radiological assessments. Postoperative hospital stay ranged from 6 to 18 days in Group 1 (mean – 10.2±3.1 days) and from 7 to 17 days in Group 2 (mean – 11.3±3.8 days; p=0.411). The duration of surgery ranged from 25 to 70 minutes (mean – 48.4±13.0 min) in Group 1 and from 45 to 70 minutes (mean – 52.5±8.2 min) in Group 2 (p=0.378). In the early postoperative period, full recovery was observed in 6 patients (33%) in Group 1 and in 2 patients (20%) in Group 2. In the long-term follow-up period, recovery rates were 63% and 70%, respectively. No mortality or disease progression was reported, and no patient required permanent shunt placement. Recurrence occurred in one patient from Group 1. Conclusions: The analysis of clinical and radiological data demonstrates the effectiveness of both ventriculocystostomy and ventriculocystocisternostomy. Both methods may be recommended for the treatment of suprasellar arachnoid cysts in children due to their minimally invasive nature, low postoperative complication rates, and absence of mortality.
Objective to improve the effectiveness of treatment of patients with lumbar spondylolisthesis, the authors substantiated and developed a novel method of minimally invasive posterior interbody vertebral stabilization (MIPIVS) using distraction cages. Materials and methods: A clinical prospective comparative (controlled) single-center interventional cross-section study was conducted with a subsequent observation phase, as well as preliminary modeling and development of a noveltervention method. The biomechanical model was used to determine the possibility of restoring the functional state of the spine using distraction cages, and the stress-strain state of the structures was analyzed. The clinical part of the study involved 21 patients aged 35 to 68 (Me=56 [LQ=50; UQ=65]) years (15 women and 6 men), divided into three groups: the study group (n=4) treated with the author's method of MIPIVS (patent application No. a202302383 dated May 18, 2023), a comparison group (n=10) with the standard method of MIPIVS, a control group (n=7) treated with other methods of interbody spondylodesis. Patients were examined according to standard protocols. Logistic and statistical analyses were performed using standard nonparametric methods at a critical level of p<0.05. The principles of bioethics and biomedicine were observed. Results: Before and after surgical treatment of patients with degenerative spondylolisthesis of the lumbar spine, the size of the spinal canal was studied and the dynamics of neurological disorders was assessed. The authors developed a novel method of minimally invasive posterior interbody stabilization of vertebrae using distraction cages and determined the possibility of restoring the value of segmental lordosis, parameters of spinal-pelvic balance and sagittal contour of the spine as indicators of the functional state of the spine using a biomechanical model. The analysis also included assessment of the stress-strain state within the "transpedicular structure – spinal motion segment – distraction cage" system. Сonclusions: The proprietary method of MIPIVS using distraction cages, which has been substantiated and developed, will help to improve the effectiveness of treatment for patients with lumbar spondylolisthesis. Further research prospects include clinical testing of the author's MIPIVS method.
Lumbar disc herniation is a prevalent spinal condition characterized by the displacement of intervertebral disc material leading to back pain and neuropathies. Surgical intervention, including decompressive laminectomy, is often recommended for patients who fail to respond to conservative treatment. The procedure of unilateral or bilateral lower half laminectomy, with or without disc herniation removal, has been described as an effective surgical technique for treating lumbar disc herniations. Purpose: The aim of the study was the assessment of outcomes including complications in patients undergoing limited laminectomy with discectomy. Material and methods: A total of 188 patients over a period from May 2022 till May 2024 were prospectively studied.Outcomes were assessed using Odom’s criteria, including complication, recovery status at subsequent follow up at 1 and 3 months. Results: Out of 188 patients, single disc herniations were seen in 155 while 2-level disc were seen in 33 cases. Among these, L5-S1 level herniation was most common , and in multi-disc herniation, L5-L5,L5-S1 levels were common. Most patients presented with radicular pain(127) followed by motor deficits or sensory deficits. Post operative recovery status was classified as excellent in the majority of cases (121 out of 188) with very less in fair and none in poor category. The recovery was gradually towards better grades in subsequent follow-ups. Duration of surgery was less than 1 hour in about 90% cases (16 out of 188). Conclusions: All cases were done under spinal anaesthesia. Adequate surgical exposure was obtained. The technique allowed for early mobilization, reduced hospital stay apart from a shorter learning curve requirement as compared to microscopic or endoscopic procedures. During discectomy the thickened ligamentum flavum (causing canal stenosis/narrowing) can also be dealt in single procedure. This procedure could be a safer alternative to the newer modalities of minimally invasive surgeries for lumbar decompression.
More than 800,000 microdiscectomies are performed annually worldwide. According to various authors, good and excellent results are about 85%, with adequate selection of patients for surgical treatment. Nevertheless, up to 40% of patients continue to suffer from pain, motor and sensory disorders, although their intensity decreases after surgery. Therefore, the search for new methods of surgical interventions that will improve the results of treatment of such patients continues. In the late 90s of the last century, the JOIMAX company (Germany) developed a technique for endoscopic transforaminal microdiscectomy, which used a lateral (transforaminal) rather than a standard interlaminar approach. According to literature data, endoscopic transforaminal microdiscectomy has up to 93% of positive outcomes. Objective. To study the immediate and long-term outcomes of treatment of patients with herniated intervertebral discs in the lumbar spine using the transforaminal endoscopic microdiscectomy method. Materials and methods. The immediate (1st day after surgery) and long-term (6th month postoperatively) outcomes of surgical treatment of 68 patients with herniated intervertebral discs in the lumbar spine were studied. Patients were operated on using the endoscopic transforaminal microdiscectomy method at the «Family Medicine Clinic», Dnipro from 2020 to 2024. Results. There were 52 men and 16 women, the age of the patients ranged from 24 to 68 years (average 44.2 years), the duration of the disease was from 6 months to 12 years. Before the operation, the average pain score according to VAS was 8.7 points. Pain syndrome on the VAS scale on the 1st day after surgery was, on average, 3.5 points, after 6 months - 3 points. After 6 months after surgery, 63 patients (93%) had good treatment outcomes according to the J. MacNab scale. Unsatisfactory results were in 5 patients (7%). Conclusions. Transforaminal endoscopic microdiscectomy is a modern highly effective minimally invasive method of surgical treatment of herniated intervertebral discs in the lumbar spine, which allows to significantly reduce intraoperative trauma, the patient’s hospital stay, accelerate the rehabilitation of patients, and improve treatment outcomes.
Introduction. Interest in this research topic arises from the fact that chronic subdural hematoma (CSDH) is currently one of the most common neurosurgical diagnoses in adults. Over the past decade, the incidence of CSDH has more than doubled. Recent studies have significantly enhanced our understanding of the mechanisms underlying the formation of CSDH, linking it to recurrent microbleeds in the subdural space from fragile, newly formed vessels within the hematoma capsule. Most of these vessels originate from the distal branches of the middle meningeal artery (MMA). Accordingly, endovascular embolization of the MMA may help eliminate chronic recurrent bleeding into the subdural space and facilitate hematoma resorption. Objective of the study. To summarize current concepts regarding the pathophysiology of CSDHs and analyze the implementation and use of endovascular embolization of the MMA in contemporary treatment strategies for CSDH based on literature data. Results. A detailed analysis of the literature indicates that a new understanding of the primary pathological process of CSDH has substantiated approaches to diagnosing and treating this pathology as an angiogenic process. Recent research findings demonstrate that endovascular embolization of the MMA in patients with CSDH is a safe and effective method to prevent recurrence or progression of subdural hematomas. Comparing different classes of embolic materials in the treatment of patients with CSDH represents the next step in ongoing research aimed at standardizing the overall treatment protocol for chronic subdural hematoma.
Objective: To develop a clear treatment strategy for multilevel protrusions and herniations of the lumbar spine using the method of percutaneous laser microdiscectomy (PLMD). Materials and Methods: The study involved 620 patients diagnosed with multilevel lumbar intervertebral disc (IVD) protrusions and herniations, all of whom underwent PLMD. The patients ranged in age from 20 to 50 years, including 360 men and 260 women. All patients underwent preoperative magnetic resonance imaging, and 62% additionally underwent computed tomography. The patients were categorized into four groups: group I (n = 78): PLMD was performed at a single level with herniations characterized by posterior-central or paramedian localization and a sagittal size not exceeding 7 mm; group II (n = 24): PLMD was performed on discs with herniations similar to those in group I, but accompanied by protrusions at other levels (sagittal size 4–6 mm); group III (n = 380): PLMD was performed in a single session on two levels with protrusions (sagittal size 4–6 mm); group IV (n = 138): PLMD was performed in a single session on three levels with protrusions (sagittal size 4–6 mm). All procedures were performed under fluoroscopic guidance using a C-arm system (Phillips, Netherlands). Pain intensity was evaluated using the Visual Analog Scale (VAS) preoperatively and during the two-week postoperative period. Treatment outcomes after one month were assessed using the McNab scale. Long-term quality of life was evaluated using the Oswestry Disability Index. Results: In Group I, the initial radicular pain (measured by VAS) was more severe but significantly decreased after one week postoperatively, while lumbar pain (lumbalgia) remained moderate over the two-week follow-up. In Group II, the reduction in radicular symptoms mirrored that of Group I, with the greatest treatment effect (d = 0.7, p < 0.05); however, lumbalgia only decreased after two weeks (p > 0.05). In Groups III and IV, radicular pain decreased similarly to Group II. However, in Group IV, the intensity of lumbalgia remained high and exceeded the baseline even after two weeks (p > 0.05). At the one-month follow-up, the highest rate of excellent outcomes was observed in Group I and the lowest in Group IV, though differences between the groups were not statistically significant (p > 0.05). These findings suggest that post-PLMD pain severity is largely influenced by lumbalgia rather than radicular pain. Conclusions: Percutaneous laser microdiscectomy is an effective method for treating protrusions and non-sequestered small herniations of the lumbar spine. The method is most appropriate and efficient when performed in a single session for two symptomatic lumbar IVD protrusions. Although it is technically feasible to treat three symptomatic protrusions in a single session, such an approach is considered less advisable.
