Objective ‒ to analyze the results of surgical treatment of cerebellar astrocytomas in young children, to establish the factors that determine the prognosis of the course of the disease.Materials and methods. The results of surgical treatment of 112 children with cerebellar astrocytoma, who were operated in Romodanov Neurosurgery Institute of NAMS of Ukraine in 1980‒2019; 59.8 % were boys, 40.2 % were girls. The age of children ‒ from 3 months to 3 years. Removal of the tumor was performed in 106 patients: in 58 ‒ totally, in 31 ‒ subtotally, in 16 ‒ partially, in 1 ‒ biopsy. Diffuse differentiated astrocytoma (low-grade (II)) was detected in 94 (83.9 %) patients, poorly differentiated diffuse astrocytoma (high-grade (III)) ‒ in 18 (16.1 %). In the cerebellum astrocytomas in 77 (68.7 %) cases were located in the midline. In 59 (52.7 %) cases astrocytomas had a cystic component, in 53 (47.3 %) cases were solid ones. Postoperative mortality over 30 years of observations was 15.2 %. Results. It was found that survival rates in the early postoperative period were statistically (p = 0.03) better in cases of total tumor resection compared with patients after with subtotal resection. In patients with diffuse differentiated astrocytoma of the cerebellum, the average duration of follow-up was 6.7 years, a good quality of life was noted in 39.4 % of patients. In the long-term follow-up period, 7.3 % of children died. In patients with poorly differentiated diffuse astrocytoma of the cerebellum, the average duration of follow-up was 4.3 years, while a satisfactory quality of life was observed in 68.0 % of patients, a poor quality in 22.0 %, and a vegetative state in 10.0 % of children. In the long-term period, 20.0 % of children died. Microscopic features of cerebellar astrocytomas are their expansive-infiltrative nature of distribution and the presence of zones of neoangiomatosis.Conclusions. It was revealed that the degree of differentiation of diffuse cerebellar astrocytomas and the radicality of their removal correlates with the quality and life expectancy of patients. The tendency of the influence of the degree of malignancy of astrocytomas on the indicators of general and reccurence-free survival of children of the younger age group was noted.

The surgical treatment results of 237 children with progressive hydrocephalus, caused by perinatal brain injury, were analyzed. The rational surgical tactics at progressive hydrocephalus was developed and applied that provided decrease of malfunctions frequency of the shunt systems from 21,9 to 9,4%, infectious-inflammatory complications — from 18,2 to 10,7%, mortality — from 8,2 to 1,5%. The program complex for prediction of hydrocephalus outcomes, caused by perinatal brain injury, was offered and quantitative evaluation of prognostic factors was made.

Проаналізовані результати хірургічного лікування прогресуючої гідроцефалії у 237 дітей, спричиненої перинатальним ураженням головного мозку. Розроблена й впроваджена раціональна хірургічна тактика при прогресуючій постгеморагічній гідроцефалії, що забезпечило зниження частоти дисфункції лікворошунтувальних систем — з 21,9 до 9,4%, інфекційно-запальних ускладнень — з 18,2 до 10,7%, смертності — з 8,2 до 1,5%. Запропонований програмний комплекс для прогнозування перебігу гідроцефалії, спричиненої перинатальним ураженням головного мозку, проведено кількісну оцінку прогностичних чинників.

Проведен анализ 2500 ликворошунтирующих операций у детей с гидроцефалией различного происхождения . С применением клинико - статистического анализа и математической обработки базы данных выделено 11 наиболее информативных показателей , итог которых позволяет с большой степенью вероятности прогнозировать возникновение гнойно - воспалительных осложнений после ликворошунтирующих операций . К таким показателям относятся: возраст ребенка, этиология гидроцефалии, ее степень, потеря веса, патология беременности и родов, пороки развития, состояние гомеостаза, гиперальбуминоз ликвора, продолжительность операции и другие. При отрицательном суммарном значении диагностических коэффициентов показателей частота осложнений не превышает 2%, а при положительной сумме более +10 частота осложнений составляет около 83% наблюдений . Предложенный комплекс профилактических мероприятий обеспечил снижение частоты гнойно - воспалительных осложнений после ликворошунтирующих операций у детей с 5 до 1,8 %.

This paper discussed the results of 2500 CSF-shunting operations in children with hydrocephalus different etiology. The authors used clinico-statical and mathematical analysis. They performed 11 of more informative indications which totally given the prognosic iduction of Suppurative infection complications. These indications included: Child age, etiology of hydrocephalus, the degree and nature of the hydrocephalus, pathology of pregnancy and childbirth, disordar of child development, weight lossing, hemostasis conditions, cerebrospinal fluid hyperalbuminosis, long-term of operative intervention and other indications. The infection complications frequency in dependented of amount the above indications. The negative amount, if the infection complications not more than 2 percent, when indications became totally (10 and more) that means positive evaluation and the frequency of infection complications appeared 83 percent of all patients. Finally the authors performed prevention of shunt infections which could be reduce the frequency of suppurative infection complications during CSF-shunting operations in children from 5 percent to 1,8 percent.

In 455 pediatric patients with progressive hydrocephaly of non-tumour genesis, a valve liquoro-shunting system was implanted. At different periods after the operation (up to 5 years), 4.8% of the patients developed the purulent-infective complications, dysfunction of a system occurred--in 20.4%. The causes, clinical signs of the emergency state are analysed, the recommendations on carrying out the therapeutic measures are given.