BACKGROUND:Craniosynostosis (CS) is a group of skull malformations manifested by congenital absence or premature closure of cranial sutures. Reconstructive surgery in the second half of life is traditional approach for CS. The issues of surgical stress response after reconstructive surgery for CS in children are still unclear.OBJECTIVE:To evaluate clinical and laboratory parameters in children undergoing traumatic reconstructive surgery for CS.MATERIAL AND METHODS:Inclusion criteria were CS, reconstructive surgery, age <24 months, no comorbidities and available laboratory diagnostic protocol including complete blood count, biochemical blood test with analysis of C-reactive protein, procalcitonin, ferritin and presepsin. The study included 32 patients (24 (75%) boys and 8 (25%) girls) aged 10.29±4.99 months after surgery between October 2021 and June 2022. Non-syndromic and syndromic forms of CS were observed in 25 (78.1%) and 7 (21.9%) cases, respectively.RESULTS:There were no infectious complications. We analyzed postoperative clinical data, fever, clinical and biochemical markers of inflammation.CONCLUSION:Early postoperative period after reconstructive surgery for CS in children is accompanied by significant increase of inflammatory markers (C-reactive protein, procalcitonin, ferritin). However, these findings do not indicate infectious complications. This is a manifestation of nonspecific systemic reaction. Severity of systemic inflammatory response syndrome with increase in acute phase proteins indicates highly traumatic reconstructive surgery for CS in children. Analysis of serum presepsin allows for differential diagnosis between infectious complication and uncomplicated course of early postoperative period.

BACKGROUND:Highly traumatic surgical correction of craniosynostosis (CS) is usually followed by severe postoperative period and high risk of complications. Surgical stress response (SSR) is an important and often neglected cause of severe early postoperative period. OBJECTIVE:To compare clinical and laboratory parameters of SSR in children who underwent various surgeries for CS. MATERIAL AND METHODS:The study included 63 patients aged 7.02±4.12 months. All ones underwent surgery for CS between October 2021 and June 2022. We analyzed clinical and laboratory markers of SSR, as well as correlation with severity of surgical stress. RESULTS:No surgical complications were observed. There were postoperative complications in 12 (19.0%) cases including febrile fever in 9 (14.3%) patients, severe pain and edematous syndromes with prolonged hospital-stay in 3 (4.8%) cases. Significant correlations were revealed between severity of surgical stress and certain laboratory markers (CRP, ACTH, T3, insulin, HOMA-IR). The last ones characterized SSR severity. Patients with high scores of stress response demonstrated more severe course of early postoperative period. CONCLUSION:Surgical stress scale makes it possible to predict early postoperative period and optimize patient management. Lower severity of surgical stress response following endoscopic interventions is another reason for the wider use of low-traumatic surgical methods in pediatric neurosurgery.

ЦЕЛЬ ИССЛЕДОВАНИЯ Определить факторы, влияющие на эффективность терапии карбамазепином при невралгии тройничного нерва. МАТЕРИАЛ И МЕТОДЫ В группу вошли 22 человека, оперированные в Центре нейрохирургии им. акад. Н.Н. Бурденко в 2019—2021 гг. по поводу невралгии тройничного нерва, получавшие до операции терапию карбамазепином. РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ В исследование включены 18 (81,8%) женщин и 4 (18,2%) мужчины, от 43 до 74 лет (медиана 62 года). В 10 (45,5%) случаях боли были слева, в 12 (54,5%) наблюдениях — справа. Длительность заболевания составила от 18 до 420 мес (медиана 102,2 мес). Длительность приема карбамазепина варьировала в тех же значениях (медиана 78 мес). Дозировка карбамазепина от 400 до 2000 мг (среднее значение 913 мг). У 10 (45,5%) пациентов имелись сопутствующие заболевания. В 12 (54,5%) случаях компрессия была вызвана ВМА, в 10 (45,5%) случаях — ПНМА; в 8 (36,4%) случаях компрессия помимо артерии была вызвана еще и веной. При увеличении возраста пациента отмечается снижение принимаемой дозировки препарата (p=0,0478245, коэффициент корреляции 0,4264066). Отмечаются статистически значимые различия по интенсивности боли в лице по ВАШ среди мужчин (среднее 9,5) и женщин (среднее 6,8) (p=0,0208915). Помимо указанных выше закономерностей не удалось выявить среди исследуемых параметров те, которые могли бы быть связаны с принимаемой дозировкой карбамазепина и интенсивностью боли по ВАШ. Не удалось определить факторы, имеющие связь с концентрацией карбамазепина в крови до операции и после с одномоментной отменой препарата. ЗАКЛЮЧЕНИЕ Оценка концентрации карбамазепина в крови с целью коррекции или подбора необходимой дозировки препарата для купирования лицевой боли по факту является неинформативным методом исследования. Интенсивность лицевой боли по ВАШ не связана с какими-либо антропометрическими, анатомическими или обменными процессами, кроме, возможно, пола пациента, а также не связана с принимаемой дозировкой карбамазепина. Назначать карбамазепин следует с малых дозировок — 100 мг дважды в день — с постепенным увеличением до достижения приемлемого анальгезирующего эффекта без побочных действий.

BACKGROUND:Delta-He the difference between hemoglobin content in reticulocytes and erytrocytes is a relatively new laboratory indicator that is easily measured in everyday practice. This parameter is directly related to iron bioavailability for hemoglobin synthesis and can reflect various conditions accompanied by cytokine expression including systemic inflammation.OBJECTIVE:To analyze the prospects for practical application of hemoglobin delta in assessment of neurosurgical patients throughout in-hospital treatment.MATERIAL AND METHODS:We analyzed complete blood counts (Sysmex XN-1000 analyzer) with optical determination of reticulocyte hemoglobin and automatic calculation of Delta-He in 82 neurosurgical patients. Exclusion criteria were severe decompensated comorbidities, exacerbation of chronic infectious processes, cancer of other organs. Blood sampling for analysis of delta-hemoglobin was carried out before all diagnostic and therapeutic measures. Reference interval is indicated by the analyzer manufacturer as 1.7-4.4 pg.RESULTS:Delta-He values at admission ranged from -1.8 to 6.1 pg. There was a consistent decrease of these values throughout 3-4 postoperative days. Then, the values could increase or continued to decrease. Increment of the index was noted in 76 patients (92.7%). Such dynamics was observed in case of uncomplicated postoperative period. Further decrease of Delta-He was observed in 6 patients (7.3%). These ones were characterized by a longer recovery after surgery, and the events required additional medical or surgical correction were recorded. Negative dynamics of Delta-He values could precede clinical manifestations of certain complication. Clarification of diagnosis and correction of therapy were accompanied by gradual increase of Delta-He values.CONCLUSION:Estimation of Delta-He values over time can be used for monitoring of patients and effectiveness of therapy. From a practical point of view, it is important that examination can be performed at any time of the day.

Introduction. Nosocomial meningitis (NM) is one of the leading complications in neurosurgery due to high mortality and disability rates.Objective. The study was aimed to determine the reference values of laboratory parameters to diagnose NM in neurosurgical patients in the intensive care unit (ICU).Results. The incidence of NM in neurosurgical patients in ICU was 8.4 (95% CI 6.8–10. 0) per 100 patients. The dominant microbial agents of NM were coagulase-negative staphylococci, A. baumannii, and K. pneumoniae. We revealed the increase in leukocytosis, C-reactive protein, and blood procalcitonin in patients with infectious complications of other systems, regardless of NM presence. Episodes of hyponatremia and an increase in body temperature ≥ 38.0 occurred signifcantly more often in patients with NM. Changes in cerebrospinal fluid (CSF) cytosis, glucose, lactate, and the CSF/blood glucose ratio can serve as reliable criteria in the NM diagnosis.Conclusions. The diagnosis of NM is most likely when the increase in CSF cytosis > 65 cells/μL, CSF lactate > 4.2 mmol/L is observed, the decrease in the CSF glucose < 2.6 mmol, and CSF/blood glucose ratio < 0.45 is found.

Management of the healthcare quality and safety is one of the priorities of state policy for protecting health of Russian citizens. We describe modern technologies for managing the quality of medical care and patient safety based on a systematic approach. Potential applications of these technologies in neurosurgical practice are defined. Quantitative, qualitative, and basic indicators are proposed for evaluation of outcomes (results) as part of implementation of an integrated quality management system in neurosurgical practice.

The article describes a rare clinical case of a patient with previously undiagnosed von Willebrand disease and basal meningioma; an intracranial neurosurgical intervention was complicated by delayed intracranial hematomas, both at the resected tumor site and distantly. The diagnosis of von Willebrand disease was established only after special hematology tests and only after surgery. Despite the use of specific therapy, the patient died due to intracranial hemorrhagic complications in the postoperative period. The paper discusses the problem of preoperative diagnosis of asymptomatic hemostasis disorders in neurosurgical patients and potential ways of its solution.

PURPOSE:to present the main topographic and anatomical features of the clivus and adjacent structures for improving and optimizing the extended endoscopic transnasal posterior (transclival) approach in removal of clival and ventral posterior cranial fossa lesions.MATERIAL AND METHODS:We performed a topographic and anatomical study of 25 cadaver heads, the vascular bed of which was filled with colored silicone using the original technique for visualizing the bed features and individual variability.RESULTS:We present the main anatomical landmarks necessary for performing the extended endoscopic endonasal posterior approach. Superior, medial, and inferior transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa.CONCLUSION:The endoscopic transclival approach can be used to reach ventral posterior cranial fossa lesions. The endoscopic transnasal transclival approach is an alternative to transcranial approaches to clival lesions.

OBJECTIVE to describe the main topographic and anatomical features of the clival region and its adjacent structures for improvement and optimization of the extended endoscopic endonasal posterior (transclival) approach for resection of tumors of the clival region and ventral posterior cranial fossa. MATERIAL AND METHODS We performed a craniometric study of 125 human skulls and a topographic anatomical study of heads of 25 cadavers, the arterial and venous bed of which was stained with colored silicone (the staining technique was developed by the authors) to visualize bed features and individual variability. Currently, we have clinical material from more than 120 surgical patients with various skull base tumors of the clival region and ventral posterior cranial fossa (chordomas, pituitary adenomas, meningiomas, cholesteatomas, etc.) who were operated on using the endoscopic transclival approach. RESULTS We present the main anatomical landmarks and parameters of some anatomical structures that are required for performing the endoscopic endonasal posterior approach. The anatomical landmarks, such as the intradural openings of the abducens and glossopharyngeal nerves, may be used to arbitrarily divide the clival region into the superior, middle, and inferior thirds. The anatomical landmarks important for the surgeon, which are detected during a topographic anatomical study of the skull base, facilitate identification of the boundaries between the different clival portions and the C1 segments of the internal carotid arteries. The superior, middle, and inferior transclival approaches provide an access to the ventral surface of the upper, middle, and lower neurovascular complexes in the posterior cranial fossa. CONCLUSION The endoscopic transclival approach may be used to access midline tumors of the posterior cranial fossa. The approach is an alternative to transcranial approaches in surgical treatment of clival region lesions. This approach provides results comparable (and sometimes better) to those of the transcranial and transfacial approaches.

The incidence rate of drainage-associated meningitis was 19.8 per 100 patients and 18.3 per 1000 days of drainage. The risk factors significantly predominating in patients with drainage-associated meningitis include the duration of drainage, association with external CSF leakage, as well as factors associated with indicators of the overall severity of the condition.

AIM:Frequency of detection determination for past and current hepatitis E virus (HEV) infection markers in children with immune suppression, as well as children with normal immune status.MATERIALS AND METHODS:The presence of HEV markers (anti-HEV IgG and IgM, HEV RNA) was studied in 609 sera samples of children with neurologic pathologies, 87 samples--from children with immune deficiencies, as well as 3122 samples from conditionally healthy children of 6 regions of Russia. The children were divided into 5 age groups. Anti-HEV IgG and IgM determination was carried out in EIA, HEV RNA--by RT-PCR.RESULTS:The frequency of detection of anamnestic anti-HEV IgG turned out to be significantly higher among immune-compromised. children compared with healthy children (5.7% against 1.4%, p < 0.05). Anti-HEV IgM, that testify to current or recent infection, were also detected significantly more frequently among children with immune-suppression (1.1-1.6%) compared with healthy children (0.25%, p < 0.05). HEV RNA was detected in 1 child with the absence of anti-HEV IgM and IgG. Nucleotide sequence analysis of HEV confirmed membership of this isolate in genotype 3, that is prevalent in non-endemic territories.CONCLUSION:The data obtained have demonstrated, that HEV-infection is prevalent among children in Russia and its course is, probably, asymptomatic in most cases. Immune suppression is a factor of increased risk of infection of children with HEV.