[Clinical and neurophysiologic aspects of surgical treatment of pharmacoresistant forms of epilepsy].

Surgical treatment of pharmacoresistant forms of epilepsy under neurophysiological monitoring is a key problem studied in A.L. Polenov Russian Neurosurgical Institute (Saint-Petersburg).

[The combined treatment of severe craniocerebral trauma taking into account the nature of the brain damages and the extent of the hypertensive-dislocation syndrome].

The intracranial pressure was measured in 95 patients with a severe cranio-cerebral trauma at the postoperative period. Four degrees of the hypertension-dislocation syndrome were established. The characteristic of operative accesses is given.

[Changes in human cerebral cortex in various areas of concussion in severe cranio-cerebral injury].

In 23 patients with a severe cranial-cerebral trauma the operative material (pieces of the cortex, obtained from the destructive, transitional and relatively preserved zones in the bruise foci with crushing, localized in various lobules of the cerebral hemispheres) has been studied. From 2 h up to 9 days after trauma, changes, characterizing the state of the vascular bed, nervous and glial cells have been followed. In the external area of the transitional zone in 15 patients and in the relatively preserved zone in all the patients reversibly altered nervous cells predominate.

[Late surgical results in severe craniocerebral trauma with foci of brain crushing].

The long-term results of treatment in 130 patients with foci of crushing in the cerebral hemispheres were studied in follow-up periods of 12 months to 12 years. It was established that compensation of the disturbed functions of the central nervous system and the extent of social-occupational adaptation are dependent on the time and volume of the operative intervention, the severity of brain damage, the patients' age, the type and degree of manifestation of the hypertensive-dislocation syndrome, and the application of a complex of intensive therapy measures. A higher level of social-occupational adaptation is achieved when the focus of brain destruction is removed within the bounds of the destruction zone and before the development of the dislocation syndrome.

[Pathogenesis of traumatic subdural hydroma].

Pathogenetic factors leading to the formation of traumatic subdural hygromas (TSH) are identified from analysis of the results of complex examination of 156 patients. Comparative biochemical tests of CSF, blood serum and the hygroma fluid in 15 patients showed the hygroma to contain CSF. The formation of TSH was always a consequence of brain contusion, usually of a severe degree, and rupture of the basal CSF cisterns.

[External drainage of the ventricular system of the brain in a complex of intensive therapy of severe craniocerebral injuries].

Indications for draining the ventricular system of the brain in patients with severe craniocerebral injury are given, based on analysis of the clinical neurological signs and the quantitative estimations. The most frequent situations in which drainage is necessary are described. Ventricular drainage should be the final stage of the principal operative intervention, namely, trephination of the skull and removal of intracranial hematomas and foci of brain crushing.

[Quantitative characteristics of cerebral blood flow and gas exchange in cerebral contusions].

Statistical characteristics of blood flow and gas exchange parameters in patients with craniocerebral injury grouped in a different manner according to the severity of the contusion, the state of consciousness, and the general condition were obtained by electric computer processing of the results of studying hemispheric blood flow by means of 133Xe clearance in 86 cases, oxygen consumption by the brain in 36 cases, and carbon dioxide excretion by the brain by Van Slyke's method in 75 cases. A close correlation was revealed between the state of the patient's consciousness and the parameters of cerebral blood flow and gas exchange; compression in severe brain contusion was found to have a statistically significant effect on cerebral blood flow and gas exchange.

[Surgical treatment in severe forms of closed craniocerebral injury].

Modern principles of diagnosis and surgical treatment of traumatic intracranial hematomas, subdural liquor hydromas, foci of crushing of cerebral hemispheres and depressed fractures of bones of the cerebral fornix are presented including reference to general surgical and traumatological hospitals. New views to the formation of intracranial hematomas and subdural liquor hydromas are described.

[Local blood flow and metabolism in a focus of cerebral crushing].

Study of ECoG, local cerebral circulation, and brain pO2 in 39 patients in the acute period of severe craniocerebral injury, as well as morphohistochemical measurements around the focus of crushing (in experiments) showed that the transitional zone is a risk zone because the "enzymatic death" of the tissue of this zone occurring at the moment of the injury predetermines extension of the areas of necrosis later on. The most effective measure is the removal not only of the detritus but also of the transitional zone of the focus within the range of tissue that had hardly suffered any changes and the inclusion of vasoactive and dehydration agents in the therapeutic complex.

[Clinico-echoencephalographic correlations in the early diagnosis of traumatic intracranial hematomas and foci of brain crushing].

The authors examined 254 patients with closed trauma of the skull and brain. Besides clinical examination all patients were subject to unidimensional multiaxial echoencephalography with a modified ultrasonic probe and method of examination Three degrees of brain affection were distinguished according to the clinical signs and three degrees of compression according to the results of echoencephalography, the combination of which allows correct tactics of examination and treatment to be used in patients with severe closed trauma of the skull and brain within the first hours of hospitalization.

[Margins for improving the results of treatment of cranio-cerebral injuries with brain compression].

Clinical and statistical analysis of information gained from observation over 1 661 patients with craniocerebral injury treated at neurosurgical clinics in 1967-74 confirmed the proposition advanced at the Leningrad Polenov Neurosurgical Institute, namely that operation for correcting compression of the brain by an intracranial hematoma should be performed as early as possible after the injury and no later than 3 hours following hospitalization.

[Time of formation of traumatic intracranial hematomas].

Biochemical study of the methemoglobin concentration (60 cases) and histological examination (40 of intracranial hematomas removed in different periods after the trauma confirmed the assumption that the main volume of these hematomas forms within the first minutes and hours after the trauma as a rule. The curve of the dependence of the methemoglobin concentration in the hematoma on the time of its formation allows the period of time which had elapsed after the trauma to be determined.

[Visceral pathology in severe cranio-cerebral injuries and its pathogenetic mechanisms].

Pathological conditions of the internal organs and their innervation apparatus, including the limbic cortex, reticular formation, vegetative nuclei of the vagus nerves and spinal cord, peripheral ganglia, and intramural plexuses, in severe craniocerebral trauma were studied by the clinico-physiological, clinico-morphological, and neurohistological methods. The innervation apparatuses of the organs were also studied in experiments with a purposeful effect exerted on the hypothalamus. Peculiarities in the manifestation of visceral pathology in diencephalic and mesencephalobulbar forms of brain lesions were established.

[Several pathophysiologic grounds for radical removal of contusion foci from the cerebral hemispheres].

Local circulation and PO2 of the cerebral tissue were studied in 26 patients during the acute period of a severe craniocerebral trauma. It was demonstrated that pronounced changes in the microcirculation developed in the area of the concussion focus in the cerebral hemispheres. Three zones of disorders in the local circulation were distinguished, and it was shown that in case of an unremoved concussion focus the extending of its necrosis zone took place.

[Frontal, or generalized, epilepsy].

The author studied the results of surgical treatment of 28 epileptic patients where the localization of the epileptogenic focus was on the medial surface of the hemisphere in the area of the frontal pole or on the lateral surface. Taking into consideration the theoretical premises, an analysis of literary data and the results of a comprehensive clinical study of patients the author comes to the conclusion that for a localization of the epileptogenic focus in the area of the pole and medio-basal parts of the frontal lobes primary generalized epileptic seizures and distant synchronous bioelectrical activity in the EEG without distinct focal changes are most characteristic.

[Medical rehabilitation medical-disability expertise of patients with post-traumatic bone defect of the skull].

The authors analyzed the results of treating 171 patients with sequelae of brain trauma and defects in the bones of the cranial fornix. On the basis of repeated examinations disturbances of brain functions were detected in 94 patients. In the remaining cases the only reason for invalidity was the cranial bone defect.

[The role of brain stem lesions in cerebral circulatory disorders accompanying severe cranio-cerebral injuries].

Clinical and anatomical comparisons were undertaken in 23 cases of mortality due to severe craniocerebral injuries. The set of clinical examinations included circulation and brain gas exchange studies. Cerebral circulatory hypoxy was revealed in all the patients, but in cases of its compensated form all signs of brain stem injury were lacking, while in cases of its non-compensated form foci of brain stem injury could be revealed at autopsy.

[Cranio-cerebral hypothermia and neuro-vegetative blockade in the systematic treatment of injuries to the skull and brain].

A method of neurovegetative blockade with and without cranio-cerebral cooling has been worked out to deal with patients with traumas of the cranium and brain of varying severity. Indications for application of the neurovegetative blockade and cranio-cerebral cooling, their intensity and duration have been defined. The application of these methods within the framework of a complex purposeful treatment of severe cerebrocranial traumas made it possible to substantially reduce the lethality among the patients and this pustified recommending it for wide clinical use.

[Alterations in several cerebral metabolic indices in patients with epilepsy].

The paper pertains to studies of some metabolic indices in the brain of 106 epileptic patients where fits were of a traumatical and inflammatory etiology and with the duration of the disease from 1-10 years. The examination revealed disorders of the reductive-oxidative processes and carbohydrate metabolism in the brain which were not related to the etiology of epilepsy. A disorder of reductive-oxidative processes were more expressed in focal nonconvulsive fits characteristic for temporal epilepsy.